Healthcare Provider Details

I. General information

NPI: 1134764921
Provider Name (Legal Business Name): DIPTI PATEL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD 2 WEST
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD 2 WEST
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-0063
  • Fax: 215-349-8144
Mailing address:
  • Phone: 215-615-0063
  • Fax: 215-349-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP020367
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: