Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | SP014457 | PA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP014457 | PA |
NPI | 1639575806 |
---|---|
Provider Name | Patricia Marie Dupak |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes Barre, PA 18711-3478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 25/05/2016 |