Individual
MARRISA SHELLEY KUBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CRNP, MS
Contact information
Practice address
2100 S 24TH ST, PHILADELPHIA, PA 19145-3222
(215) 952-8611
Mailing address
2100 S 24TH ST, PHILADELPHIA, PA 19145-3222
(215) 952-8611
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN287003L
PA
363LP0200X
Pediatric Nurse Practitioner
Primary
SP011636
PA
Other
Enumeration date
06/13/2007
Last updated
09/07/2015
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