Individual
PATRICIA WALLACE BELANCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1722 BETHLEHEM PIKE, FLOURTOWN, PA 19031-1644
(215) 233-9700
(215) 233-9710
Mailing address
PO BOX 820933, PHILADELPHIA, PA 19182-0933
(215) 926-9010
(215) 226-8285
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP011629
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100727800
MEDICAID TPI GROUP
PA
01
—
597586
MEDICARE TPI GROUP
PA
01
—
CD4829
RAILROAD MEDICARE TPI GROUP
PA
Enumeration date
06/08/2012
Last updated
06/08/2012
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