Healthcare Provider Details

I. General information

NPI: 1992708713
Provider Name (Legal Business Name): ADINA S. GUTSTEIN MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 CHESTNUT ST
PHILADELPHIA PA
19107-5104
US

IV. Provider business mailing address

273 GOLDENROD DR
UPPER GWYNEDD PA
19446-7605
US

V. Phone/Fax

Practice location:
  • Phone: 215-629-1158
  • Fax: 215-825-5914
Mailing address:
  • Phone: 267-613-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTP006745C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: