Individual
CRYSTAL CORCORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
475 SPRING LN, PHILADELPHIA, PA 19128-3918
(215) 482-5353
Mailing address
475 SPRING LN, PHILADELPHIA, PA 19128-3918
(215) 482-5353
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
618192
PA
247100000X
Radiologic Technologist
408831
PA
Other
Enumeration date
05/03/2016
Last updated
05/03/2016
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