Healthcare Provider Details

I. General information

NPI: 1700425584
Provider Name (Legal Business Name): MONIKA KATHERINE WASIK MSN, WHNP-BC, CBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON AVE
PHILADELPHIA PA
19147-4717
US

IV. Provider business mailing address

2243 CATHARINE ST
PHILADELPHIA PA
19146-1703
US

V. Phone/Fax

Practice location:
  • Phone: 215-339-5100
  • Fax:
Mailing address:
  • Phone: 610-772-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP021048
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: