Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | OS012313 | PA |
Y | 207V00000X | Obstetrician & Gynecologist | OS012313 | PA |
NPI | 1063447852 |
---|---|
Provider Name | Dr. Kristi L Dively |
First Address | Ephrata, PA 17522 |
Second Address | Ephrata, PA 17522-2601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 01/05/2019 |