Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC-002771-L | PA |
Y | 222Z00000X | Podiatrist | SC-002771-L | PA |
NPI | 1013019801 |
---|---|
Provider Name | Paula F, Raugellis |
First Address | Waynesburg, PA 15370-8269 |
Second Address | Waynesburg, PA 15370-8269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T30501 | (02) | PA |