Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP012917 | PA |
NPI | 1073866760 |
---|---|
Provider Name | Heather Medica |
First Address | Philadelphia, PA 19145-2315 |
Second Address | Philadelphia, PA 19145-2315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 01/11/2016 |