Healthcare Provider Details

I. General information

NPI: 1841673621
Provider Name (Legal Business Name): JOHANNAH LEBOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ FARM JOURNAL BUIDING, 2ND FLOOR
PHILADELPHIA PA
19106-3585
US

IV. Provider business mailing address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-6088
  • Fax:
Mailing address:
  • Phone: 215-840-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP014842
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: