Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP017377 | PA |
NPI | 1043743966 |
---|---|
Provider Name | Rebecca Prosser |
First Address | Philadelphia, PA 19107-4420 |
Second Address | Philadelphia, PA 19107-4420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2017 |
Last Update Date | 15/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103300667 | (05) | PA |