Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP024626 | PA |
NPI | 1003570912 |
---|---|
Provider Name | Andriy Bashta |
First Address | Philadelphia, PA 19115-4283 |
Second Address | Abington, PA 19001-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2021 |
Last Update Date | 26/10/2021 |