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NPI Code Detail

MEDICARE: MS. MARY A VERDERAME CRNP

MEDICARE: MS. MARY A VERDERAME 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
1363L00000XNurse PractitionerSP006657BPA
2363LP2300XPrimary Care Nurse PractitionerSP006657BPA

General Provider Information

NPI Number : 1861465106
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY A VERDERAME CRNP
Provider Business Mailing Address
First Line : 3900 WOODLAND AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-4551
Country : US
Telephone Number : 215-823-5800
Fax Number :
Provider Business Practice Location Address
First Line : 3900 WOODLAND AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-4551
Country : US
Telephone Number : 215-823-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 01/12/2021

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