Individual
MERCEDES JULIA DETTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
111 N 49TH ST, PHILADELPHIA, PA 19139-2718
(215) 471-2600
Mailing address
913 S 51ST ST APT 4, PHILADELPHIA, PA 19143-3260
(267) 650-5454
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP031168
PA
Other
Enumeration date
11/30/2024
Last updated
11/30/2024
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