Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | TP004609C | PA |
NPI | 1023006897 |
---|---|
Provider Name | Elizabeth Ann Prechtel Dunphy |
First Address | Philadelphia, PA 19104-2640 |
Second Address | Philadelphia, PA 19104-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 20/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S67285 | (02) |