Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC-007831-L | PA |
NPI | 1407951031 |
---|---|
Provider Name | Sean Bernard Labuda |
First Address | Mcmurray, PA 15317-2530 |
Second Address | Washington, PA 15301-5106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001961028 | (05) | PA |
46028 | HIGHMARK (01) | PA |
U82195 | (02) | PA |