Healthcare Provider Details

I. General information

NPI: 1790103414
Provider Name (Legal Business Name): AMY RAPINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD 2ND FLOOR- WOOD CENTER
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD 2ND FLOOR- WOOD CENTER
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1527
  • Fax:
Mailing address:
  • Phone: 215-590-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP013771
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: