Individual
TIFFANY WISDOM-GOULBOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
217 HARRISBURG AVE, LANCASTER, PA 17603-2964
(717) 544-8300
Mailing address
30 EDISON RD, DOUGLASSVILLE, PA 19518-2449
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP029670
PA
Other
Enumeration date
06/06/2024
Last updated
05/07/2025
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