Healthcare Provider Details

I. General information

NPI: 1083603930
Provider Name (Legal Business Name): MARYANN MARAKOWITZ SHATZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD FL 5
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-4200
  • Fax: 215-881-9587
Mailing address:
  • Phone: 215-707-8484
  • Fax: 215-707-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberUP004491C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: