Individual
MRS. ALICIA TAYLOR BRUSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
425 NORTH 21ST STREET, SUITE 405, CAMP HILL, PA 17011
(717) 695-6553
(855) 383-3233
Mailing address
425 NORTH 21ST STREET, SUITE 405, CAMP HILL, PA 17011
(717) 695-6553
(855) 383-3233
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
OA004204
PA
363AM0700X
Medical Physician Assistant
Primary
MA060420
PA
363AS0400X
Surgical Physician Assistant
MA060420
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103340644
—
PA
01
—
MA060420
NEW LICENSE NUMBER
PA
Enumeration date
06/13/2017
Last updated
07/31/2019
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