Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD66113L | PA |
N | 208000000X | Pediatrician | MD066113L | PA |
N | 2080P0201X | Pediatric Allergist | MD066113L | PA |
NPI | 1639199912 |
---|---|
Provider Name | Janet L Beausoleil |
First Address | Ardmore, PA 19003-2395 |
Second Address | Ardmore, PA 19003-2395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001701726 | (05) | PA |
7638108 | (05) | NJ |
G76448 | (02) |