Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP008599 | PA |
NPI | 1003842188 |
---|---|
Provider Name | Ms. Joan E La Joie |
First Address | Philadelphia, PA 19102-2100 |
Second Address | Philadelphia, PA 19123-3658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 20/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10146118470001 | (05) | PA |