Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP009221 | PA |
NPI | 1033317391 |
---|---|
Provider Name | Regina Ann Halliday |
First Address | Philadelphia, PA 19104-5502 |
Second Address | Philadelphia, PA 19104-5502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 01/03/2013 |