Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | UP000720C | PA |
NPI | 1003940222 |
---|---|
Provider Name | Josepha Louise Brown |
First Address | Broad Top, PA 16621-0127 |
Second Address | Broad Top, PA 16621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |