Healthcare Provider Details

I. General information

NPI: 1922496017
Provider Name (Legal Business Name): NORTHERN VALLEY PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W 21ST ST
NORTHAMPTON PA
18067-1221
US

IV. Provider business mailing address

44 W 21ST ST
NORTHAMPTON PA
18067-1221
US

V. Phone/Fax

Practice location:
  • Phone: 610-261-0999
  • Fax:
Mailing address:
  • Phone: 610-261-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014436
License Number StatePA

VIII. Authorized Official

Name: MS. MARY KATHLEEM MURPHY
Title or Position: CERTIFIED REGISTERED NURSE PRACTITI
Credential: CRNP, FNP-C
Phone: 610-360-8751