Healthcare Provider Details

I. General information

NPI: 1548365794
Provider Name (Legal Business Name): BETH ANN HEUER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ANN COHEN CRNP

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3500 N. BROAD STREET RM 001A
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-5437
  • Fax: 215-707-5180
Mailing address:
  • Phone: 215-926-9022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP007398
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: