Individual
MRS. PEGGY ANNE DERUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
7505 BUSTLETON AVE, PHILADELPHIA, PA 19152-4136
(215) 333-7505
Mailing address
7505 BUSTLETON AVE, PHILADELPHIA, PA 19152-4136
(215) 333-7505
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
SP021349
PA
Other
Enumeration date
01/10/2020
Last updated
01/10/2020
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