Healthcare Provider Details

I. General information

NPI: 1689669194
Provider Name (Legal Business Name): MARY E POLLICE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 9TH ST SUITE 500
PHILADELPHIA PA
19107-6810
US

IV. Provider business mailing address

211 S 9TH ST SUITE 500
PHILADELPHIA PA
19107-6810
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6175
  • Fax: 215-955-9783
Mailing address:
  • Phone: 215-955-6175
  • Fax: 215-955-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007217
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: