Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Mar 14, 2022
License(s)
SP024345 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 3322 N BROAD ST | Philadelphia, PA 19140-5185 | 215-707-1800 |
| MAILING | 3500 N BROAD STREET ROOM 001A | Philadelphia, PA 19140-4106 | 215-926-9022 |
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