Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | SP019934 | PA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | SP019934 | PA |
NPI | 1063978278 |
---|---|
Provider Name | Kailey Taylor Mandes |
First Address | Pittsburgh, PA 15217-2501 |
Second Address | Pittsburgh, PA 15213-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2019 |
Last Update Date | 12/02/2019 |