Healthcare Provider Details

I. General information

NPI: 1760966956
Provider Name (Legal Business Name): GIANA INDELICATO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 N BROAD ST
PHILADELPHIA PA
19140-4160
US

IV. Provider business mailing address

416 E MYRTLE AVE
TREVOSE PA
19053-3338
US

V. Phone/Fax

Practice location:
  • Phone: 215-430-4000
  • Fax:
Mailing address:
  • Phone: 215-801-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP019307
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: