Individual
ALEXIS MARIE WYETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
151 STAHL RD, SOUTHAMPTON, PA 18966-3273
(215) 901-6112
Mailing address
151 STAHL RD, SOUTHAMPTON, PA 18966-3273
(215) 901-6112
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP030147
PA
363LG0600X
Gerontology Nurse Practitioner
SP030147
PA
Other
Enumeration date
07/26/2024
Last updated
07/26/2024
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