Individual
CRYSTAL PAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 873-7888
Mailing address
231 ASHBURN RD, PHOENIXVILLE, PA 19460-4808
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP026895
PA
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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