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 | 363LA2200X | Nurse Practitioner | Adult Health | RN332145L | PENNSYLVANIA | No |
| 2 | 363LA2200X | Nurse Practitioner | Adult Health | TP006953C | 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 | 470888939 | OTHER | | PHCS |
| 2 | 2119896001 | OTHER | | AMERIHEALTH HMO |
| 3 | 278862 | OTHER | | MAMSI |
| 4 | 4708888939 | OTHER | | DEVON |
| 5 | CK4397 | OTHER | | MEDICARE RAILROAD |
| 6 | PC0140 | OTHER | | HEALTH NET |
| 7 | 007302 | OTHER | | AETNA HMO |
| 8 | P56095 | MEDICARE UPIN | | |
| 9 | 0001435061 | OTHER | | PERSONAL CHOICE 65 |
| 10 | 21198960001 | OTHER | | KEYSTONE HEALTH PLAN EAST |
| 11 | 4708888939 | OTHER | | FIRST HEALTH CCN |
| 12 | 1058232 | OTHER | | KEYSTONE MERCY HEALTH PLA |
| 13 | 21198960001 | OTHER | | KEYSTONE HLTHPLAN EAST 65 |
| 14 | P543147 | OTHER | | OXFORD |
| 15 | 007302 | OTHER | | AETNA PPO MANAGED CARE |
| 16 | 2119896001 | OTHER | | AMERIHEALTH ADMINISTRATOR |
| 17 | 470888939 | OTHER | | INTERCOUNTY |
| 18 | 598899143 | OTHER | | MULTI PLAN |
| 19 | 0001435061 | OTHER | | PENNSYLVANIA BLUE SHIELD |
| 20 | 056725Q3D | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
