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Individual

MARTHA Y SUMO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
829 MACDADE BLVD, COLLINGDALE, PA 19023-3733
(484) 494-4772
Mailing address
829 MACDADE BLVD, COLLINGDALE, PA 19023-3733

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN302513
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1457772808
SKILLED NURSING
05
1457772808
PA
Enumeration date
10/02/2018
Last updated
10/02/2018
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