Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP018549 | PA |
N | 363LA2100X | Nurse Practitioner - Acute Care | SP018549 | PA |
N | 363LC1500X | Nurse Practitioner - Community Health | SP018549 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP018549 | PA |
NPI | 1467016246 |
---|---|
Provider Name | Ticora Elizabeth Marable |
First Address | Abington, PA 19001-2414 |
Second Address | Philadelphia, PA 19152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2019 |
Last Update Date | 26/04/2019 |