Healthcare Provider Details

I. General information

NPI: 1407113988
Provider Name (Legal Business Name): KIMBERLY STRAUCH RN, MSN, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST SUITE 239
PHILADELPHIA PA
19107-5002
US

IV. Provider business mailing address

2144 CECIL B MOORE AVE
PHILADELPHIA PA
19121-4014
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax:
Mailing address:
  • Phone: 215-320-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP011818
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: