Healthcare Provider Details

I. General information

NPI: 1457510828
Provider Name (Legal Business Name): AMY L BYRNE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4306
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4306
US

V. Phone/Fax

Practice location:
  • Phone: 267-425-7310
  • Fax: 215-590-6301
Mailing address:
  • Phone: 267-425-7310
  • Fax: 215-590-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN525953L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP009048
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: