Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | OS008049 | PA |
NPI | 1134536238 |
---|---|
Provider Name | Dr. Kristina Marie Newcomer |
First Address | Etters, PA 17319-9412 |
Second Address | Etters, PA 17319-9412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2014 |
Last Update Date | 21/07/2014 |