Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS009631L | PA |
NPI | 1003811829 |
---|---|
Provider Name | Heidi Susan Bee |
First Address | Sharon, PA 16146-2057 |
Second Address | Mercer, PA 16137-5019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 19/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H20784 | (02) |