Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP021065 | PA |
NPI | 1033755301 |
---|---|
Provider Name | Glenda Tam |
First Address | Philadelphia, PA 19143-1887 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2019 |
Last Update Date | 21/11/2019 |