Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | MW010077 | PA |
NPI | 1053419853 |
---|---|
Provider Name | Mrs. Renee D Pistilli |
First Address | York, PA 17403-4829 |
Second Address | York, PA 17403-4829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101154612 | (05) | PA |
1542778 | GATEWAY-WMG (01) | PA |
974233 | CAREFIRST MD BCBS (01) | MD |