Individual
MARY LONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2534 S 18TH ST, PHILADELPHIA, PA 19145-3701
(215) 463-4363
Mailing address
2534 S 18TH ST, PHILADELPHIA, PA 19145-3701
(215) 463-4363
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN695130
PA
363LF0000X
Family Nurse Practitioner
Primary
SP019604
PA
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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