Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Pediatrics |
363LP0200X | 50 | Nurse Practitioner |
| NPI Number | 1265087993 |
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| LBN Legal business name | PONY EXPRESS PEDIATRICS, LLC | ||||
| Authorized official | CHRISTA KOVACHEVICH - (OWNER/APRN CPNP-PC) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | Yes | ||||
| Enumeration date | 08/08/2019 | ||||
| Last updated | 08/08/2019 - About 7 years ago | ||||
| Identifiers |
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