Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP018866 | PA |
NPI | 1043706880 |
---|---|
Provider Name | Hryhory Yakymiv |
First Address | Huntingdon Valley, PA 19006-8411 |
Second Address | Lansdale, PA 19446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 05/09/2018 |