Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 960914 | PA |
NPI | 1124690276 |
---|---|
Provider Name | Fabienne Pepe |
First Address | Feasterville Trevose, PA 19053-6701 |
Second Address | Feasterville Trevose, PA 19053-6701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2021 |
Last Update Date | 16/07/2021 |