Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 34.014167 | OH |
Y | 111NI0900X | Internist | 34.014167 | OH |
NPI | 1003346388 |
---|---|
Provider Name | Mrs. Jessica Harriman Austin |
First Address | Boardman, OH 44512-6725 |
Second Address | Boardman, OH 44512-6725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 08/01/2022 |