Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS015456 | PA |
Y | 207Q00000X | Family Doctor | OS015456 | PA |
NPI | 1023326592 |
---|---|
Provider Name | Natalie L. Laniewicz |
First Address | Titusville, PA 16354-1724 |
Second Address | Titusville, PA 16354-1724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2010 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1026896650002 | (05) | PA |
237182D7A | MEDICARE (01) | PA |
OS015456 | UNRESTRICTED PA LICENSE (01) | PA |
OTO12722 | D.O. TRAINING LICENSE (01) | PA |