Healthcare Provider Details

I. General information

NPI: 1811570112
Provider Name (Legal Business Name): NURSES UNITED AGAINST COVID19
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 WARREN STREET
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

5751 PINE ST
PHILADELPHIA PA
19143-1215
US

V. Phone/Fax

Practice location:
  • Phone: 267-254-9771
  • Fax: 215-382-5803
Mailing address:
  • Phone: 267-254-9771
  • Fax: 215-382-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAVEDA JUNE GRAHAM
Title or Position: CHIEF MEDICAL OFFICER
Credential: CRNP
Phone: 267-588-2328