Individual
MRS. GINNA ELIZABETH DEITRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE STREET, INTERVENTIONAL RADIOLOGY, PHILADELPHIA, PA 19104-4206
(215) 662-3005
Mailing address
3400 SPRUCE STREET, PHILADELPHIA, PA 19104-4206
(215) 662-3005
Taxonomy
Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
RN556396
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
SP009820
PA
Other
Enumeration date
01/14/2008
Last updated
08/15/2019
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