Healthcare Provider Details

I. General information

NPI: 1396952578
Provider Name (Legal Business Name): ALISON YEZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SPROUL ROAD SUITE 206
BROOMALL PA
19008
US

IV. Provider business mailing address

2000 SPROUL ROAD SUITE 206
BROOMALL PA
19008
US

V. Phone/Fax

Practice location:
  • Phone: 610-284-0200
  • Fax: 610-353-7932
Mailing address:
  • Phone: 610-284-0200
  • Fax: 610-353-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP008399
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: