Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife |
NPI | 1063789030 |
---|---|
Provider Name | Jennifer Zucal Kelly |
First Address | Emporium, PA 15834-1417 |
Second Address | Emporium, PA 15834-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2011 |
Last Update Date | 19/10/2014 |