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NPI Code Detail

MEDICARE: MATENNEH ABU

MEDICARE: MATENNEH ABU
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
1163WS0200XSchool Registered NurseL10025660DE
2163WC1500XCommunity Health Registered NurseRN515514LPA

General Provider Information

NPI Number : 1790829695
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATENNEH ABU
Provider Business Mailing Address
First Line : 7248 ELMWOOD AVE
Second Line :
City : PHILA
State : PA
Zip : 19142-1533
Country : US
Telephone Number : 267-292-2647
Fax Number : 267-292-2657
Provider Business Practice Location Address
First Line : 7248 ELMWOOD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19142-1533
Country : US
Telephone Number : 267-292-2647
Fax Number : 267-292-2657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 06/10/2011

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