Individual
LINE ST-VIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 ROBBINS ST, PHILADELPHIA, PA 19111-5764
(267) 770-8542
Mailing address
520 ROBBINS ST, PHILADELPHIA, PA 19111-5764
(267) 770-8542
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN291699
PA
Other
Enumeration date
01/20/2021
Last updated
01/20/2021
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