Individual
MARYELLEN FAVATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 316-5151
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN653863
PA
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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