Healthcare Provider Details

I. General information

NPI: 1023683075
Provider Name (Legal Business Name): ROSEMARY HYNES KOUL MSN, CRNP, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

4342 PARK SOUTH STATION BLVD
CHARLOTTE NC
28210-4481
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 540-207-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberSP023755
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: