MEDICARE: MS. IRENE SOELLER 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP008987	PA

General Provider Information

NPI Number	:	1912944570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRENE SOELLER CRNP

Provider Business Mailing Address
First Line	:	3900 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3120
Country	:	US
Telephone Number	:	609-213-9216
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3120
Country	:	US
Telephone Number	:	609-213-9216
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/01/2016

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