Healthcare Provider Details

I. General information

NPI: 1003842188
Provider Name (Legal Business Name): JOAN E LA JOIE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CALLOWHILL ST SUITE 101
PHILADELPHIA PA
19123-3658
US

IV. Provider business mailing address

1500 MARKET ST LM 500 WEST TOWER
PHILADELPHIA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-825-8220
  • Fax: 215-825-8254
Mailing address:
  • Phone: 215-985-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP008599
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: