Individual
MS. SIA KATHERINE FILLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2146 S BROAD ST, PHILA, PA 19145-3905
(267) 519-0672
Mailing address
134 W SHARPNACK ST, PHILA, PA 19119-4033
(267) 736-3800
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN269566
PA
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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