Healthcare Provider Details

I. General information

NPI: 1912105198
Provider Name (Legal Business Name): VANESHA MASHON KNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESHA HARRIS

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 WALNUT ST
PHILADELPHIA PA
19139-3706
US

IV. Provider business mailing address

5800 RIDGE AVE
PHILADELPHIA PA
19128-1737
US

V. Phone/Fax

Practice location:
  • Phone: 215-476-6264
  • Fax:
Mailing address:
  • Phone: 215-509-6819
  • Fax: 215-487-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007347
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: