Healthcare Provider Details

I. General information

NPI: 1093189607
Provider Name (Legal Business Name): ASHA AVIRACHEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 3 SILVERSTEIN
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 SPRUCE ST 3 SILVERSTEIN
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3487
  • Fax: 215-349-5534
Mailing address:
  • Phone: 215-662-3487
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP015677
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: