Healthcare Provider Details

I. General information

NPI: 1619514403
Provider Name (Legal Business Name): REBECCA TANG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 11/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N WEST END BLVD STE 102
QUAKERTOWN PA
18951-1272
US

IV. Provider business mailing address

PO BOX 1111
HARLEYSVILLE PA
19438-0907
US

V. Phone/Fax

Practice location:
  • Phone: 215-538-0202
  • Fax: 215-538-9580
Mailing address:
  • Phone: 215-453-4995
  • Fax: 215-453-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020905
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: