MEDICARE: MEIRU ZHAO FNP

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	163W00000X	Registered Nurse	L1-0053872	DE
2	363L00000X	Nurse Practitioner	LG-0001259	DE
3	363LF0000X	Family Nurse Practitioner	SP018513	PA
4	363LF0000X	Family Nurse Practitioner	LG-0001259	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	YXQ123196725001	OTHER	PA	KEYSTONE PLAN EAST

General Provider Information

NPI Number	:	1659878387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEIRU ZHAO FNP

Provider Business Mailing Address
First Line	:	312 S HENDERSON RD
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-2408
Country	:	US
Telephone Number	:	610-205-1264
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2431
Country	:	US
Telephone Number	:	302-317-1531
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	03/04/2025

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