Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | SP019097 | PA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP019097 | PA |
NPI | 1023591534 |
---|---|
Provider Name | Amy Kathryn Santalucia |
First Address | Harrisburg, PA 17102-2715 |
Second Address | York, PA 17401-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2018 |
Last Update Date | 11/09/2018 |