Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP024695 | PA |
NPI | 1023775822 |
---|---|
Provider Name | Mackenzie Erin Reffert |
First Address | Lancaster, PA 17601-5886 |
Second Address | Lancaster, PA 17602-2250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2021 |
Last Update Date | 29/11/2021 |