Healthcare Provider Details

I. General information

NPI: 1548291594
Provider Name (Legal Business Name): DARLENE MARIE BEWICK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST STE 703
PHILADELPHIA PA
19107-4409
US

IV. Provider business mailing address

833 CHESTNUT ST SUITE 703
PHILADELPHIA PA
19107-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1000
  • Fax: 215-503-2066
Mailing address:
  • Phone: 215-955-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP-007741
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: