Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AG04180018 | PA |
NPI | 1003301920 |
---|---|
Provider Name | Mrs. Johanna Marie Farinella |
First Address | Huntingdon Valley, PA 19006-1511 |
Second Address | Philadelphia, PA 19114-1025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2018 |
Last Update Date | 22/06/2018 |