Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP017115 | PA |
NPI | 1023554078 |
---|---|
Provider Name | Jennifer Bish |
First Address | Trevose, PA 19053-6647 |
Second Address | Trevose, PA 19053-6647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2017 |
Last Update Date | 16/01/2017 |