Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD059697L | PA |
NPI | 1346278397 |
---|---|
Provider Name | Dr. Jennifer Lynne Delozier |
First Address | State College, PA 16803-2276 |
Second Address | State College, PA 16803-2276 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 20/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G21648 | (02) | PA |