Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Nov 21, 2014
License(s)
SP016120 (PA), LG-0000797 (DE)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 537 STANTON CHRISTIANA RD SUITE 201 | Newark, DE 19713-2146 | 302-994-9692 |
| MAILING | 3400 CIVIC CENTER BLVD 2 WEST | Philadelphia, PA 19104-5127 | 215-615-0062 |
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