Healthcare Provider Details

I. General information

NPI: 1386736627
Provider Name (Legal Business Name): CHRISTOPHER VERICA CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

416 VALLEY VIEW ROAD
SPRINGFIELD PA
19064
US

V. Phone/Fax

Practice location:
  • Phone: 484-454-8700
  • Fax: 484-454-8706
Mailing address:
  • Phone: 610-604-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NJ00005400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NR1028550
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSPO11640
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: