Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MT211401 | PA |
Y | 208600000X | Surgeon | MT211401 | PA |
NPI | 1003264623 |
---|---|
Provider Name | Jovanna Micole Linnen |
First Address | Philadelphia, PA 19102-1101 |
Second Address | Philadelphia, PA 19102-1101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 25/05/2016 |