Healthcare Provider Details

I. General information

NPI: 1598970873
Provider Name (Legal Business Name): NANCY ROE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N SHADY RETREAT RD SUITES 3 AND 4
DOYLESTOWN PA
18901-2503
US

IV. Provider business mailing address

708 N SHADY RETREAT RD SUITES 3 AND 4
DOYLESTOWN PA
18901-2503
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-6090
  • Fax: 215-345-6119
Mailing address:
  • Phone: 215-345-6090
  • Fax: 215-345-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberUP004021D
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRN239457L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRN LICENSE
# 2
IdentifierUP004021D
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCRNP LICENSE
# 3
Identifier96699
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNURSING CERTIFICATE
# 4
Identifier000998
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPRESCRIPTION AUTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: