Individual
HA LAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
930 WASHINGTON AVE, PHILADELPHIA, PA 19147-3840
(215) 627-8000
(215) 627-9265
Mailing address
1401 S 31ST ST, 2ND FLOOR, PHILADELPHIA, PA 19146-3506
(215) 925-2400
(215) 925-9162
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
RN676335
PA
363LP0200X
Pediatric Nurse Practitioner
Primary
SP016940
PA
Other
Enumeration date
12/03/2016
Last updated
04/06/2017
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