Healthcare Provider Details

I. General information

NPI: 1992791818
Provider Name (Legal Business Name): WILNA CAPITA A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 HOLME AVE STE 203
PHILADELPHIA PA
19152-2029
US

IV. Provider business mailing address

2701 HOLME AVE STE 203
PHILADELPHIA PA
19152-2029
US

V. Phone/Fax

Practice location:
  • Phone: 215-331-0515
  • Fax:
Mailing address:
  • Phone: 215-331-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP009315
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: