Healthcare Provider Details

I. General information

NPI: 1487855466
Provider Name (Legal Business Name): JOANNE MARIE PATYKULA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE CHILDREN'S HOSPITAL OF PHILADELPHIA 34TH AND CIVIC CENTER BOULEVARD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

150 E COUNTRY CLUB DR
WESTAMPTON NJ
08060-4732
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberUP-003588-O
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: