Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP018805 | PA |
NPI | 1003305178 |
---|---|
Provider Name | Nicole Leigh Pomeroy I |
First Address | Punxsutawney, PA 15767-2605 |
Second Address | Punxsutawney, PA 15767-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2018 |
Last Update Date | 11/09/2019 |