Healthcare Provider Details

I. General information

NPI: 1164464798
Provider Name (Legal Business Name): KATHLEEN BOCZAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N 9TH ST SUITE 104
PHILADELPHIA PA
19122-1909
US

IV. Provider business mailing address

1500 MARKET STREET LM 500 WEST TOWER
PHILADELPHIA PA
19120-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-765-6690
  • Fax: 215-765-6694
Mailing address:
  • Phone: 215-985-2595
  • Fax: 215-765-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP000980B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: