Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP003419H | PA |
NPI | 1053585430 |
---|---|
Provider Name | Mary Ley |
First Address | Pittsburgh, PA 15213-2536 |
Second Address | Pittsburgh, PA 15213-2536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |