Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | MD461730 | PA |
NPI | 1073931788 |
---|---|
Provider Name | Jesse Blank |
First Address | Altoona, PA 16601-4818 |
Second Address | Altoona, PA 16601-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 24/05/2021 |