Organization
PENNSYLVANIA HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE M NICHOLS (PROVIDER ENROLLMENT SPECIALIST)
(706) 650-0705
Entity
Organization
Contact information
Practice address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6130
(706) 650-0705
Mailing address
163 WESLEY AVE, CHERRY HILL, NJ 08002-3744
(856) 857-9387
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
26NO11347600
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
RN616965
PA
Other
Enumeration date
09/04/2013
Last updated
09/04/2013
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