Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | SP020359 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP020359 | PA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP020359 | PA |
NPI | 1043877897 |
---|---|
Provider Name | Sandi Pino |
First Address | Conshohocken, PA 19428-3820 |
Second Address | Conshohocken, PA 19428-3820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 30/04/2021 |