Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MA061205 | PA |
NPI | 1033754510 |
---|---|
Provider Name | Isabela Marlene Tetino |
First Address | Canonsburg, PA 15317-6058 |
Second Address | Canonsburg, PA 15317-6058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2019 |
Last Update Date | 08/11/2019 |