Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | RT007125 | PA |
Y | 213ES0000X | Sports Medicine | RT007125 | PA |
NPI | 1407324205 |
---|---|
Provider Name | Jenna Hirsch |
First Address | Ebensburg, PA 15931-1629 |
Second Address | Loretto, PA 15940-9734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2018 |
Last Update Date | 09/11/2018 |