| NPI | 1164775342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE ROSA Owner 607-237-1209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP009050) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA BM2828929) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2012-10-25 |