Individual
MARY FANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-6060
Mailing address
2437 ARDSLEY AVE, GLENSIDE, PA 19038-3701
(215) 806-3284
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP026285
PA
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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