Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 35.082974 | OH |
N | 2080P0216X | Pediatric Rheumatologist | 35.082974 | OH |
NPI | 1134336100 |
---|---|
Provider Name | Lisa Kay Petiniot |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 02/02/2015 |