Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | OS016843 | PA |
NPI | 1003135955 |
---|---|
Provider Name | Nicole Lynn Renaldi |
First Address | Philadelphia, PA 19107-4824 |
Second Address | Philadelphia, PA 19107-4824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 09/07/2015 |