Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | TP004280D | PA |
NPI | 1033385166 |
---|---|
Provider Name | Marjorie Severo-Stewart |
First Address | Meadville, PA 16335-2566 |
Second Address | Meadville, PA 16335-2566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 08/05/2008 |