Healthcare Provider Details

I. General information

NPI: 1639904246
Provider Name (Legal Business Name): ANN ILUFOYE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 WALNUT ST
PHILADELPHIA PA
19139-3836
US

IV. Provider business mailing address

5800 WALNUT ST
PHILADELPHIA PA
19139-3836
US

V. Phone/Fax

Practice location:
  • Phone: 215-474-4444
  • Fax: 215-474-6021
Mailing address:
  • Phone: 215-474-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NJ15128500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP030299
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: