Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP023218 | PA |
NPI | 1043802648 |
---|---|
Provider Name | Awilda Rodriguez |
First Address | Bryn Mawr, PA 19010-3118 |
Second Address | Bryn Mawr, PA 19010-3118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2021 |
Last Update Date | 02/03/2021 |