Healthcare Provider Details

I. General information

NPI: 1154694800
Provider Name (Legal Business Name): ANNIE ELIZABETH MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD CARDIAC CENTER 6 EAST
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD CARDIAC CENTER 6 EAST
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 267-425-6300
  • Fax: 215-590-6690
Mailing address:
  • Phone: 267-435-6300
  • Fax: 215-590-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP011894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: