Healthcare Provider Details

I. General information

NPI: 1184371379
Provider Name (Legal Business Name): THERESA BELL MCEVOY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 W BALTIMORE PIKE STE 2205
MEDIA PA
19063-5136
US

IV. Provider business mailing address

9 WASHINGTON WAY
SWEDESBORO NJ
08085-4219
US

V. Phone/Fax

Practice location:
  • Phone: 610-744-2960
  • Fax:
Mailing address:
  • Phone: 610-731-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP025210
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: