Organization
BLUE MOUNTAIN WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUCILLE CONSTANTINE CRNP (OWNER)
(215) 647-2175
Entity
Organization
Contact information
Practice address
517 N BROAD ST, LANSDALE, PA 19446-2415
(215) 647-2175
Mailing address
517 N BROAD ST, LANSDALE, PA 19446-2415
(215) 647-2175
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1037502590001
—
PA
01
—
1194082347
INDIVIDUAL NPI
PA
Enumeration date
06/19/2019
Last updated
01/11/2023
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