Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP022901 | PA |
NPI | 1003412834 |
---|---|
Provider Name | Ellen Ruth Dreibelbis |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2020 |
Last Update Date | 19/01/2021 |