Healthcare Provider Details

I. General information

NPI: 1023729522
Provider Name (Legal Business Name): LUALHATI PAHILANGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST AVE STE 910S
JENKINTOWN PA
19046-2642
US

IV. Provider business mailing address

100 WEST AVE STE 910S
JENKINTOWN PA
19046-2642
US

V. Phone/Fax

Practice location:
  • Phone: 215-245-2131
  • Fax:
Mailing address:
  • Phone: 215-245-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN765970
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: