Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP013420 | PA |
NPI | 1003246851 |
---|---|
Provider Name | Kate Cordisco |
First Address | White Haven, PA 18661-3803 |
Second Address | White Haven, PA 18661-3803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2013 |
Last Update Date | 24/11/2020 |