Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | C1-0003175 | DE |
Y | 208600000X | Surgeon | C1-0003175 | DE |
NPI | 1003838806 |
---|---|
Provider Name | Emily Penman |
First Address | Wilmington, DE 19805-7170 |
Second Address | Newark, DE 19713-2055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 12/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000231501 | (05) | DE |
F04128 | (02) |