Healthcare Provider Details

I. General information

NPI: 1851255715
Provider Name (Legal Business Name): ILINA MAI CRNP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N BROAD ST
PHILADELPHIA PA
19122-6003
US

IV. Provider business mailing address

1801 N BROAD ST
PHILADELPHIA PA
19122-6003
US

V. Phone/Fax

Practice location:
  • Phone: 215-204-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP034238
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: