Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP022818 | PA |
NPI | 1093310443 |
---|---|
Provider Name | Isamar Rivera |
First Address | Chambersburg, PA 17201-4232 |
Second Address | Chambersburg, PA 17201-1035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2020 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093310443 | NPI (01) |