Healthcare Provider Details

I. General information

NPI: 1538426424
Provider Name (Legal Business Name): MRS. PAULINE S COUSINEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULINE K SPAETZEL NP

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W BALTIMORE PIKE SUITE 304
WEST GROVE PA
19390-9446
US

IV. Provider business mailing address

111 CROMWELL DR
LINCOLN UNIVERSITY PA
19352-1120
US

V. Phone/Fax

Practice location:
  • Phone: 610-869-1278
  • Fax:
Mailing address:
  • Phone: 610-999-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP012053
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: