Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | TP005859V | PA |
NPI | 1073585634 |
---|---|
Provider Name | Mrs. Amy Lyter Stauffer |
First Address | Hershey, PA 17033-2360 |
Second Address | Hershey, PA 17033-2086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 13/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1399970 | HIGHMARK BLUE SHIELD (01) | PA |
50026640 | CAPITAL BLUE CROSS (01) | PA |
P68445 | (02) | PA |