Healthcare Provider Details

I. General information

NPI: 1720747223
Provider Name (Legal Business Name): GLORIA KASEMI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 REECEVILLE RD
COATESVILLE PA
19320-1542
US

IV. Provider business mailing address

201 REECEVILLE RD
COATESVILLE PA
19320-1542
US

V. Phone/Fax

Practice location:
  • Phone: 610-383-8000
  • Fax:
Mailing address:
  • Phone: 610-383-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2000307060
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN684623
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number26NR21484800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: