Healthcare Provider Details

I. General information

NPI: 1497356190
Provider Name (Legal Business Name): NADRIA YASMEEN KASUMU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 11/08/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 MOUNTAIN AVE
ELKINS PARK PA
19027-3022
US

IV. Provider business mailing address

7401 MOUNTAIN AVE
ELKINS PARK PA
19027-3022
US

V. Phone/Fax

Practice location:
  • Phone: 215-964-0989
  • Fax:
Mailing address:
  • Phone: 215-964-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP022787
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP022787
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP022787
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: