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Organization
MERCY MANAGEMENT OF SEPA
Active
Organization
MERCY MANAGEMENT OF SEPA
Active
Other names
SEPA Midlevel Practioners
Organization subpart
No
Provider details
NPI number
Authorized official
AMIEE BRENNAN (CREDENTIALING SUPERVISOR)
(610) 567-6964
Entity
Organization
Contact information
Practice address
1503 LANSDOWNE AVE STE 3003, DARBY, PA 19023-1308
(484) 494-6862
(484) 494-8414
Mailing address
1 W ELM ST, CONSHOHOCKEN, PA 19428-4108
(610) 567-6967
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/17/2017
Last updated
03/17/2018
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