Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | TP000746G | PA |
NPI | 1063408219 |
---|---|
Provider Name | Ms. Michelle Eileen Woltz |
First Address | Horsham, PA 19044-3412 |
Second Address | Philadelphia, PA 19106-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 07/01/2009 |