Healthcare Provider Details

I. General information

NPI: 1821539784
Provider Name (Legal Business Name): OMOROWA OBANOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CHESTERBROOK BLVD.
BERWYN PA
19312-3805
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-5454
  • Fax: 215-349-5534
Mailing address:
  • Phone: 215-615-5454
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP031434
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: