Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP022530 | PA |
NPI | 1083227276 |
---|---|
Provider Name | Nicole Rose Spector |
First Address | Philadelphia, PA 19143-3634 |
Second Address | Jamaica Plain, MA 02130-2615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 16/02/2021 |