Healthcare Provider Details

I. General information

NPI: 1619973278
Provider Name (Legal Business Name): BARBARA BRAVERMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD YORK RD STE 203
JENKINTOWN PA
19046-2872
US

IV. Provider business mailing address

500 OLD YORK RD STE 203
JENKINTOWN PA
19046-2872
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-0174
  • Fax:
Mailing address:
  • Phone: 215-886-0174
  • Fax: 215-886-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberUP005045C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: