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NPI Code Detail

MEDICARE: PROF. PAMELA Z CACCHIONE PHD, CRNP, BC

MEDICARE: PROF. PAMELA Z CACCHIONE PHD, CRNP, BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner018136PA

General Provider Information

NPI Number : 1407297179
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. PAMELA Z CACCHIONE PHD, CRNP, BC
Provider Business Mailing Address
First Line : 4508 CHESTNUT ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-3608
Country : US
Telephone Number : 215-572-7300
Fax Number :
Provider Business Practice Location Address
First Line : 4508 CHESTNUT ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-3608
Country : US
Telephone Number : 215-572-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2013
Last Update Date : 07/10/2013

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