Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1063014967 |
---|---|
Provider Name | Carol Poorman Shih |
First Address | Ardmore, PA 19003-2508 |
Second Address | Ardmore, PA 19003-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2020 |
Last Update Date | 15/11/2020 |