Healthcare Provider Details

I. General information

NPI: 1366537318
Provider Name (Legal Business Name): CHILDRENS HEALTH CARE ASSOCIATE'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 E PENN SQ FL 9 CHCA NURSE PRACTITIONERS
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax: 267-425-9299
Mailing address:
  • Phone: 267-425-9200
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number StatePA

VIII. Authorized Official

Name: MIXZA SANTA
Title or Position: ENROLLMENT MANAGER
Credential:
Phone: 267-425-9233