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Individual

MARY KATE ROTH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-6060
Mailing address
2518 CHRISTIAN ST, PHILADELPHIA, PA 19146-2314
(240) 383-0050

Taxonomy

Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
SP027437
PA

Other

Enumeration date
04/13/2023
Last updated
04/13/2023
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