Healthcare Provider Details

I. General information

NPI: 1053662247
Provider Name (Legal Business Name): MICHELLE HALL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 SECOND STREET PIKE
RICHBORO PA
18954-1803
US

IV. Provider business mailing address

41 UNIVERSITY DR STE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 215-710-2770
  • Fax: 215-710-2772
Mailing address:
  • Phone: 215-710-7037
  • Fax: 215-710-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP012273
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: