Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN.204632-COA1 | OH |
NPI | 1063790731 |
---|---|
Provider Name | Penelope L Hedman |
First Address | Sagamore Hills, OH 44067-2960 |
Second Address | Sagamore Hills, OH 44067-2960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2011 |
Last Update Date | 26/11/2012 |