Healthcare Provider Details

I. General information

NPI: 1164057469
Provider Name (Legal Business Name): JOY ANGELYN DEPPEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 HOFFNAGLE ST
PHILADELPHIA PA
19152-2229
US

IV. Provider business mailing address

1625 HOFFNAGLE ST
PHILADELPHIA PA
19152-2229
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN714084
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: