Healthcare Provider Details

I. General information

NPI: 1841400223
Provider Name (Legal Business Name): BERNADETTE MOMOH MSN FNP-C /PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S CHAPEL ST STE 102
NEWARK DE
19713-3468
US

IV. Provider business mailing address

1800 LOMBARD ST STE 206
PHILADELPHIA PA
19146-1414
US

V. Phone/Fax

Practice location:
  • Phone: 253-346-0137
  • Fax:
Mailing address:
  • Phone: 215-662-2222
  • Fax: 215-893-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017176
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025399
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010299
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: