Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP020925 | PA |
NPI | 1235770702 |
---|---|
Provider Name | John Bak |
First Address | Williamsport, PA 17701-1900 |
Second Address | Williamsport, PA 17701-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2019 |
Last Update Date | 15/06/2021 |