Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 16020003 | PA |
NPI | 1114474095 |
---|---|
Provider Name | Mrs. Tyler Wilson |
First Address | Chester Springs, PA 19425-2904 |
Second Address | Chester Springs, PA 19425-2904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 08/09/2016 |