Healthcare Provider Details

I. General information

NPI: 1508398819
Provider Name (Legal Business Name): ANNIE ZAVITSANOS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE LEE CRNP

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2500
  • Fax: 215-728-3639
Mailing address:
  • Phone: 215-728-2500
  • Fax: 215-728-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP017103
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: