Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP021221 | PA |
NPI | 1013556877 |
---|---|
Provider Name | Pauline Nelin |
First Address | Philadelphia, PA 19103-3844 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2019 |
Last Update Date | 06/07/2020 |