Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW010047 | PA |
NPI | 1013909829 |
---|---|
Provider Name | Jane E. Hearren |
First Address | Ephrata, PA 17522-9550 |
Second Address | Ephrata, PA 17522-1761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 16/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01971534 | (05) | PA |