Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD024344E | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MD024344E | PA |
NPI | 1235104217 |
---|---|
Provider Name | Dr. Lela W. Brink |
First Address | Danville, PA 17822-3034 |
Second Address | State College, PA 16803-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E08341 | (02) |