Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS041127 | PA |
NPI | 1235665894 |
---|---|
Provider Name | Nicole Deakins |
First Address | Wayne, PA 19087-2523 |
Second Address | Wayne, PA 19087-2523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2017 |
Last Update Date | 02/05/2017 |