Healthcare Provider Details

I. General information

NPI: 1922301845
Provider Name (Legal Business Name): AFRODITE PATOUNAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH STREET AND CIVIC CENTER BOULEVARD
PHILADELPHIA PA
19104-4399
US

IV. Provider business mailing address

28629 SCHOOL HOUSE RD
COLUMBUS NJ
08022-1838
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 267-918-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberSP011147
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: