Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MT200141 | PA |
Y | 208000000X | Pediatrician | MT200141 | PA |
NPI | 1770877904 |
---|---|
Provider Name | Rebecca Ahrens-Nicklas |
First Address | Philadelphia, PA 19104-4399 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 06/06/2011 |