Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP020160 | PA |
NPI | 1093276289 |
---|---|
Provider Name | Mr. William J Ravert JR. |
First Address | Mechanicsburg, PA 17050-2008 |
Second Address | Mechanicsburg, PA 17050-3616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2019 |
Last Update Date | 29/03/2019 |