Individual
MRS. MARIA ESTELA O PRUDENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
503 N 21ST ST, CAMP HILL, PA 17011-2204
(717) 763-2205
Mailing address
523 HALYARD WAY, ENOLA, PA 17025-1327
(717) 763-2205
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
MD035793E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1682792
—
PA
Enumeration date
04/19/2007
Last updated
07/08/2007
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