Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | OT021292 | PA |
NPI | 1679063119 |
---|---|
Provider Name | Lillian Grace Mauroner |
First Address | Pittsburgh, PA 15213-3410 |
Second Address | Pittsburgh, PA 15224-1529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 12/07/2021 |