Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP011801 | PA |
NPI | 1003184953 |
---|---|
Provider Name | Carley Bober |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2011 |
Last Update Date | 27/05/2014 |