Healthcare Provider Details

I. General information

NPI: 1154259737
Provider Name (Legal Business Name): LORPU VANKPANAH KABBAH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CHADDS FORD DR UNIT M-20
CHADDS FORD PA
19317-7354
US

IV. Provider business mailing address

610 CHADDS FORD DR UNIT M-20
CHADDS FORD PA
19317-7354
US

V. Phone/Fax

Practice location:
  • Phone: 484-784-7379
  • Fax:
Mailing address:
  • Phone: 484-784-7379
  • Fax: 877-919-9246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP035090
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: