Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 364SA2200X | Clinical Nurse Specialist | Adult Health | MA050801 | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 21198960001 | OTHER | | KEYSTON HLT PLAN EAST 65 |
| 2 | 2119896001 | OTHER | | AMERIHEALTH HMO |
| 3 | P00044991 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 4 | 0001435061 | OTHER | | PERSCHOICE PERSCHOICE 65 |
| 5 | 071587 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
| 6 | 007302 | OTHER | | AETNA PPO MANAGED CARE |
| 7 | P543147 | OTHER | | OXFORD |
| 8 | 4708888939 | OTHER | | DEVON |
| 9 | 4708888939 | OTHER | | FIRST HEALTH CCN |
| 10 | 470888939 | OTHER | | INTERCOUNTY |
| 11 | P55475 | MEDICARE UPIN | | |
| 12 | 0001435061 | OTHER | | PENNSULVANIA BLUE SHIELD |
| 13 | CK4397 | OTHER | | MEDICARE RAILROAD |
| 14 | 007302 | OTHER | | AETNA HMO |
| 15 | 1058232 | OTHER | | KEYSTONE MERCY HEALTH PLA |
| 16 | 2119896001 | OTHER | | AMERIHEALTH ADMINISTRATOR |
| 17 | 278862 | OTHER | | MAMSI |
| 18 | 598899143 | OTHER | | MULTI PLAN |
| 19 | PC0140 | OTHER | | HEALTH NET |
| 20 | 21198960001 | OTHER | | KEYSTONE HEALTH PLAN EAST |
