Individual
DIMITRA CHRISTOFORATOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 SPROUL ROAD, SUITE 206, BROOMALL, PA 19008
(610) 284-0200
(610) 353-7932
Mailing address
2000 SPROUL ROAD, SUITE 206, BROOMALL, PA 19008
(610) 284-0200
(610) 353-7932
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP008184
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003706
PRESCRIPTION AUTH
PA
01
—
RN526518L
RN LICENSE
PA
01
—
SP008184
CRNP LICENSE
PA
Enumeration date
05/14/2007
Last updated
11/10/2014
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