Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 35-088594 | OH |
Y | 2084N0402X | Child Neurologist | MD064744L | PA |
NPI | 1124190368 |
---|---|
Provider Name | Rowena Engracia Foronda Rivera |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 28/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017054580003 | (05) | PA |
014368 | (02) | PA |