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General NPI Number Information
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NPI Number | 1639609696
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Entity Type | Individual
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Provider Name | ALICIA TAYLOR BRUSTEIN PA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 425 NORTH 21ST STREET SUITE 405
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City | CAMP HILL
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State | PA
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Zip | 17011
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Country | US
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Telephone | 717-695-6553
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Fax | 855-383-3233
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Provider Business Mailing Address
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Address Line | 425 NORTH 21ST STREET SUITE 405
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City | CAMP HILL
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State | PA
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Zip | 17011
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Country | US
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Telephone | 717-695-6553
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Fax | 855-383-3233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA004204
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MA060420
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA060420
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License Number State | PA
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