Healthcare Provider Details

I. General information

NPI: 1265081780
Provider Name (Legal Business Name): RENA LINDEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 CHESTNUT ST
PHILADELPHIA PA
19139-3205
US

IV. Provider business mailing address

5501 CHESTNUT ST
PHILADELPHIA PA
19139-3205
US

V. Phone/Fax

Practice location:
  • Phone: 215-748-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP020761
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: