Healthcare Provider Details

I. General information

NPI: 1801059522
Provider Name (Legal Business Name): ALYSON STAGG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH AND CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4399
US

IV. Provider business mailing address

2545 DAMIAN DR
HATBORO PA
19040-3715
US

V. Phone/Fax

Practice location:
  • Phone: 267-426-6881
  • Fax: 215-590-0456
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP009546
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberSP009545
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: