Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | SP022092 | PA |
NPI | 1164035515 |
---|---|
Provider Name | Ms. Analene Tunacao |
First Address | Folcroft, PA 19032-1011 |
Second Address | Wilmington, DE 19805-4917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 26/08/2020 |