Individual
IVELISSE RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
212 WILLOW VALLEY LAKES DR, WILLOW STREET, PA 17584-9668
(717) 224-5819
Mailing address
212 WILLOW VALLEY LAKES DR, WILLOW STREET, PA 17584-9668
(717) 224-5819
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN286931
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN286931
LPN
PA
Enumeration date
03/12/2019
Last updated
03/12/2019
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