Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | DN22308 | FL |
Y | 1223P0300X | Periodontist | DS039766 | PA |
NPI | 1104378611 |
---|---|
Provider Name | Natalie Amoa |
First Address | Philadelphia, PA 19152-2733 |
Second Address | Philadelphia, PA 19152-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2016 |
Last Update Date | 03/06/2019 |