Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC006219 | PA |
Y | 222Z00000X | Podiatrist | SC006219 | PA |
N | 213EP0504X | Public Medicine | SC006219 | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC006219 | PA |
N | 111NR0200X | Radiology | SC006219 | PA |
N | 213ER0200X | Radiology | SC006219 | PA |
N | 2081S0010X | Sports Medicine | SC006219 | PA |
N | 213ES0000X | Sports Medicine | SC006219 | PA |
N | 213ES0103X | Foot & Ankle Surgery | SC006219 | PA |
N | 213ES0131X | Foot Surgery | SC006219 | PA |
NPI | 1649584764 |
---|---|
Provider Name | Miss Ellianne Marie Nasser |
First Address | Danville, PA 17822-4903 |
Second Address | Scranton, PA 18510-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 13/08/2020 |