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Organization

TPS II OF PA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY GENEVIEVE D'AGOSTINO CRNA (CRNA)
(484) 678-8690
Entity
Organization

Contact information

Practice address
245 N 15TH ST, NCB ROOM 7502, PHILADELPHIA, PA 19102-1101
(215) 762-4312
Mailing address
900 IRVINGTON PL, CHESTER, PA 19013-5216
(484) 678-8690

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN559969
PA

Other

Enumeration date
05/17/2011
Last updated
06/22/2012
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