Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP001420H | PA |
NPI | 1053442111 |
---|---|
Provider Name | Mrs. Suzan Weller Fine |
First Address | Elkins Park, PA 19027-2910 |
Second Address | Elkins Park, PA 19027-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 04/09/2015 |