Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS039719 | PA |
Y | 213EG0000X | General Practice | DS039719 | PA |
NPI | 1003244542 |
---|---|
Provider Name | Dr. Glenda Eidenshink |
First Address | Richboro, PA 18954-1083 |
Second Address | Richboro, PA 18954-1083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2013 |
Last Update Date | 09/04/2015 |