Healthcare Provider Details

I. General information

NPI: 1861710162
Provider Name (Legal Business Name): NANCY YATES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 OLD YORK RD SUITE210
ABINGTON PA
19001-3800
US

IV. Provider business mailing address

PO BOX 1287
BLUE BELL PA
19422-0410
US

V. Phone/Fax

Practice location:
  • Phone: 215-517-1100
  • Fax: 215-517-1130
Mailing address:
  • Phone: 484-530-0205
  • Fax: 484-530-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP10267
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: