Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP022502 | PA |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | SP022502 | PA |
NPI | 1033703640 |
---|---|
Provider Name | Tiffany D Casimiro |
First Address | Hanover, PA 17331-2275 |
Second Address | Hanover, PA 17331-2275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2021 |
Last Update Date | 07/06/2021 |