Individual
HENRIETTA D MTSHALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2100 W GIRARD AVE, PHILADELPHIA, PA 19130-1400
(215) 685-0800
(215) 865-0846
Mailing address
2301 S BROAD ST, PHILADELPHIA, PA 19148-3542
(215) 952-1408
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA003230L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
597586
MEDICARE GROUP
PA
01
—
CD4829
RR MEDICARE GROUP
PA
Enumeration date
12/13/2007
Last updated
03/18/2016
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