Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Jul 14, 2022
License(s)
26NJ01337200 (NJ), SP029938 (PA), SP029938 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 3803 W CHESTER PIKE STE 160 | Newtown Square, PA 19073-2336 | |
| LOCATION | 1991 SPROUL RD STE 130 | Broomall, PA 19008-3512 | 484-565-1293 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.