Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | OS019555 | PA |
NPI | 1043653603 |
---|---|
Provider Name | Julia Leddy |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2013 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OS019555 | STATE LICENSE (01) | PA |