Healthcare Provider Details

I. General information

NPI: 1477673499
Provider Name (Legal Business Name): DEBORAH LYN HART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HICKORY RD
PLYMOUTH MEETING PA
19462-1047
US

IV. Provider business mailing address

301 MALLARD DR
MARLTON NJ
08053-1211
US

V. Phone/Fax

Practice location:
  • Phone: 610-834-1122
  • Fax: 610-834-7525
Mailing address:
  • Phone: 856-983-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number26NR08083200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: