Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | R191354 | MD |
NPI | 1063882660 |
---|---|
Provider Name | Mrs. Shannon Bomberger |
First Address | Quarryville, PA 17566-9242 |
Second Address | Quarryville, PA 17566-9242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2015 |
Last Update Date | 25/09/2015 |