Healthcare Provider Details

I. General information

NPI: 1265936819
Provider Name (Legal Business Name): MONJAMA KORNGOR CRNP-FP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

IV. Provider business mailing address

46 ELDON AVE
LANSDOWNE PA
19050-1815
US

V. Phone/Fax

Practice location:
  • Phone: 610-447-2000
  • Fax: 610-874-7241
Mailing address:
  • Phone: 610-659-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018380
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: