Healthcare Provider Details

I. General information

NPI: 1841769411
Provider Name (Legal Business Name): HEANA YI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S 10TH ST
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

105 RAMPART PL
MAPLE GLEN PA
19002-2861
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6000
  • Fax:
Mailing address:
  • Phone: 267-346-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberSP020351
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020351
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: