Individual
GEORGES THEODULE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
561 FAIRTHORNE AVE, PHILADELPHIA, PA 19128-2412
(215) 487-4000
Mailing address
561 FAIRTHORNE AVE, PHILADELPHIA, PA 19128-2412
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP027645
PA
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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