Healthcare Provider Details

I. General information

NPI: 1134341688
Provider Name (Legal Business Name): NANCY WAHL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HADDONFIELD-BERLIN ROAD SUITE 210
VOORHEES NJ
08043
US

IV. Provider business mailing address

919 EDGEWOOD ROAD
HAVERTOWN PA
19083
US

V. Phone/Fax

Practice location:
  • Phone: 856-782-2212
  • Fax: 856-782-2213
Mailing address:
  • Phone: 610-446-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberVP000920J
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: