Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP2300X | Nurse Practitioner - Primary Care | SP000098A | PA |
NPI | 1023091733 |
---|---|
Provider Name | Joan P Midon |
First Address | Sharon, PA 16146-1503 |
Second Address | Beaver Falls, PA 15010-4217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S54056 | (02) | PA |