Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP023408 | PA |
NPI | 1003582008 |
---|---|
Provider Name | Caroline Bloss |
First Address | Philadelphia, PA 19145-4324 |
Second Address | Philadelphia, PA 19145-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2021 |
Last Update Date | 19/08/2021 |