Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 26NJ00412700 | NJ |
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP011398 | PA |
NPI | 1003191883 |
---|---|
Provider Name | Ling Fan |
First Address | Philadelphia, PA 19107-4824 |
Second Address | Philadelphia, PA 19107-4824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2011 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102867945 | (05) | PA |