Individual
LEIA MAREE FAVANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-2000
Mailing address
139 MORRIS AVE, WOODLYN, PA 19094-1717
(484) 574-3400
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP014746
PA
Other
Enumeration date
08/02/2016
Last updated
08/02/2016
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