Healthcare Provider Details

I. General information

NPI: 1760783716
Provider Name (Legal Business Name): MARIE H POPP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE HOTTENSTEIN

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 17TH ST SUITE 201
ALLENTOWN PA
18104-5052
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 484-664-7850
  • Fax: 484-664-7864
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010659
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: