Healthcare Provider Details

I. General information

NPI: 1457918211
Provider Name (Legal Business Name): KASSIE LEE BISCOE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CHERRY ST STE 11484
PHILADELPHIA PA
19102-1312
US

IV. Provider business mailing address

1601 CHERRY ST STE 11484
PHILADELPHIA PA
19102-1312
US

V. Phone/Fax

Practice location:
  • Phone: 215-255-7304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN645007
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: