Healthcare Provider Details

I. General information

NPI: 1154203156
Provider Name (Legal Business Name): VIRGINIA URDANETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

1230 BRIDGEWATER DR
WEST CHESTER PA
19380-3992
US

V. Phone/Fax

Practice location:
  • Phone: 215-316-5151
  • Fax:
Mailing address:
  • Phone: 610-322-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN691914
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: