Healthcare Provider Details

I. General information

NPI: 1528875432
Provider Name (Legal Business Name): ANNE PUTHETTU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

2260 BELLFLOWER LN
NEW HOPE PA
18938-5504
US

V. Phone/Fax

Practice location:
  • Phone: 361-877-1016
  • Fax:
Mailing address:
  • Phone: 361-877-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP030803
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: