Healthcare Provider Details

I. General information

NPI: 1073941308
Provider Name (Legal Business Name): DACEY BOINAIV STRATTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SOUTH ST
PHILADELPHIA PA
19146-1529
US

IV. Provider business mailing address

4522 SPRUCE ST
PHILADELPHIA PA
19139-4525
US

V. Phone/Fax

Practice location:
  • Phone: 215-454-8000
  • Fax: 215-893-2251
Mailing address:
  • Phone: 207-664-8738
  • Fax: 215-893-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP013271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: