Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD027615L | PA |
NPI | 1023007689 |
---|---|
Provider Name | Marianne Bouvier |
First Address | Kittanning, PA 16201-7132 |
Second Address | Kittanning, PA 16201-7132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 24/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006863020003 | (05) | PA |
180040964 | RAILROAD MEDICARE (01) | |
B33779 | (02) |