MEDICARE: EMILY FREDERICK 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	SP03067	PA

General Provider Information

NPI Number	:	1740009356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY FREDERICK CRNP

Provider Business Mailing Address
First Line	:	2301 E ALLEGHENY AVE # 203
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19134-4427
Country	:	US
Telephone Number	:	215-426-5566
Fax Number	:	215-739-7304

Provider Business Practice Location Address
First Line	:	2301 E ALLEGHENY AVE # 203
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19134-4427
Country	:	US
Telephone Number	:	215-426-5566
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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