Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD038689L | PA |
NPI | 1083789424 |
---|---|
Provider Name | Maya S Ruetschi |
First Address | Lewisburg, PA 17837 |
Second Address | Lewisburg, PA 17837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B40361 | (02) |