Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD041816L | PA |
N | 2080P0210X | Pediatric Nephrologist | MD041816L | PA |
NPI | 1437293701 |
---|---|
Provider Name | Dr. Jill A. Largent |
First Address | Danville, PA 17822-3034 |
Second Address | Wilkes Barre, PA 18702-3507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B81810 | (02) |