Individual
SUJA MATHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
10203 CLARK ST, PHILADELPHIA, PA 19116-3814
(267) 312-2843
Mailing address
10203 CLARK ST, PHILADELPHIA, PA 19116-3814
(267) 312-2843
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP022353
PA
Other
Enumeration date
02/24/2021
Last updated
02/24/2021
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