Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | OS009764L | PA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | OS009764L | PA |
NPI | 1033128467 |
---|---|
Provider Name | June A Wallison |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19107-6130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 17/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001728167 | (05) | PA |
8643008 | (05) | NJ |
G84841 | (02) |