Healthcare Provider Details

I. General information

NPI: 1255662334
Provider Name (Legal Business Name): VANESSA RENEE LYTES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST 8TH FLOOR PP
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

3401 N BROAD ST 8TH FLOOR PP
PHILADELPHIA PA
19140-5103
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-6230
  • Fax: 215-707-2684
Mailing address:
  • Phone: 215-707-6230
  • Fax: 215-707-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP005705C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: