MEDICARE: NANCY LINH CRNP

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
1	363LF0000X	Family Nurse Practitioner	SP014595	PA

General Provider Information

NPI Number	:	1497146492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LINH CRNP

Provider Business Mailing Address
First Line	:	1840 SOUTH ST STE 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-7421
Country	:	US
Telephone Number	:	215-839-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 SOUTH ST STE 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-7421
Country	:	US
Telephone Number	:	215-839-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	11/26/2018

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