Individual
MRS. LIEZL RASGO DIDONATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
111 S 11TH ST, SUITE 6270, PHILADELPHIA, PA 19107-4824
(215) 955-4912
(215) 923-0835
Mailing address
111 S 11TH ST, SUITE 6270, PHILADELPHIA, PA 19107-4824
(215) 955-8304
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP012329
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102925771
—
PA
Enumeration date
03/07/2014
Last updated
07/22/2015
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