Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | LP-0000181 | DE |
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP017561 | PA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | LP-0000181 | DE |
NPI | 1548717556 |
---|---|
Provider Name | John J Taxiera |
First Address | Philadelphia, PA 19104-2640 |
Second Address | Philadelphia, PA 19104-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 29/09/2017 |