Healthcare Provider Details

I. General information

NPI: 1013142835
Provider Name (Legal Business Name): CERTIFIED PERIOPERATIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CYPRESS ST
PHILADELPHIA PA
19103-6508
US

IV. Provider business mailing address

211 SOUTH ST # 230
PHILADELPHIA PA
19147-2305
US

V. Phone/Fax

Practice location:
  • Phone: 215-605-1748
  • Fax:
Mailing address:
  • Phone: 215-605-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number00000
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number00000
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0000000
License Number StatePA

VIII. Authorized Official

Name: VESNA MILICA HESS
Title or Position: CEO
Credential: CRNP,CRNFA
Phone: 215-605-1748