Healthcare Provider Details

I. General information

NPI: 1225195241
Provider Name (Legal Business Name): MARIE SCHROEDER MCCLAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST FRNT 1
PHILADELPHIA PA
19107-4420
US

IV. Provider business mailing address

615 CHESTNUT ST FL 14
PHILADELPHIA PA
19106-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-5000
  • Fax: 215-923-1089
Mailing address:
  • Phone: 215-955-1120
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP002055G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: