Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS019547 | PA |
NPI | 1316372667 |
---|---|
Provider Name | Dr. Adrienne Marie Mccallister |
First Address | Williamsport, PA 17701-1900 |
Second Address | Williamsport, PA 17701-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 09/04/2020 |