Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | SP020538 | PA |
Y | 363L00000X | Nurse Practitioner | SP020538 | PA |
NPI | 1063065456 |
---|---|
Provider Name | Pauline Elaine Greene |
First Address | King Of Prussia, PA 19406-3101 |
Second Address | Bryn Mawr, PA 19010-1352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2019 |
Last Update Date | 25/07/2019 |