Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP60518948 | WA |
N | 363LA2100X | Nurse Practitioner - Acute Care | 4704324415 | MI |
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP019797 | PA |
NPI | 1013299197 |
---|---|
Provider Name | Sirithepphavanh Oliver |
First Address | Philadelphia, PA 19104-5127 |
Second Address | Philadelphia, PA 19104-5127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2011 |
Last Update Date | 05/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013299197 | (05) | WA |