Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP014452 | PA |
NPI | 1003214388 |
---|---|
Provider Name | Erica Goulston |
First Address | Philadelphia, PA 19107-5211 |
Second Address | Philadelphia, PA 19107-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2014 |
Last Update Date | 18/12/2014 |