Individual
JUSTIN EGOVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
80001 STATE RD., MHM CORRECTIONAL SERVICES, MOD II, PHILADELPHIA, PA 19136-0000
(215) 624-0797
Mailing address
257 WINDING WAY, MERION STATION, PA 19066-1225
(610) 668-9528
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP011762
PA
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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