Healthcare Provider Details

I. General information

NPI: 1639625809
Provider Name (Legal Business Name): GINA SLOBOGIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CHERRY TREE RD
UPPER CHICHESTER PA
19014-2406
US

IV. Provider business mailing address

400 CHERRY TREE RD
UPPER CHICHESTER PA
19014-2406
US

V. Phone/Fax

Practice location:
  • Phone: 610-485-6700
  • Fax:
Mailing address:
  • Phone: 610-485-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberSP016510
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: