Healthcare Provider Details

I. General information

NPI: 1669586913
Provider Name (Legal Business Name): KELLY MCCANN STENGEL MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 PENNSYLVANIA AVE SUITE 105
FORT WASHINGTON PA
19034-3403
US

IV. Provider business mailing address

455 PENNSYLVANIA AVE STE 105
FORT WASHINGTON PA
19034-3404
US

V. Phone/Fax

Practice location:
  • Phone: 215-793-4546
  • Fax: 215-793-9007
Mailing address:
  • Phone: 215-793-4546
  • Fax: 215-793-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP007120
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: