Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP013335 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP013335 | PA |
NPI | 1053742189 |
---|---|
Provider Name | Michael A Stawnychy |
First Address | Philadelphia, PA 19104 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2013 |
Last Update Date | 27/11/2013 |