Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | SP019922 | PA |
NPI | 1184198160 |
---|---|
Provider Name | Lauren Martin |
First Address | Erie, PA 16506-6134 |
Second Address | Erie, PA 16507-1502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2019 |
Last Update Date | 15/06/2021 |