Healthcare Provider Details

I. General information

NPI: 1174256952
Provider Name (Legal Business Name): PATREL A CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 WALNUT ST
PHILADELPHIA PA
19139-3836
US

IV. Provider business mailing address

2900 N HARRISON ST
WILMINGTON DE
19802-2935
US

V. Phone/Fax

Practice location:
  • Phone: 215-474-4444
  • Fax:
Mailing address:
  • Phone: 215-609-5798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR250650
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberSP025231
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: