Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1356670483 |
---|---|
Provider Name | Ms. Johanna Hernandez |
First Address | Wayne, PA 19087-5203 |
Second Address | Wayne, PA 19087-5203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2009 |
Last Update Date | 20/12/2009 |