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General NPI Number Information
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NPI Number | 1063075919
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Entity Type | Organization
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Legal Business Name | ELITE PROVIDER MANAGEMENT, LLC
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 941 CHURCH LN
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City | LANSDOWNE
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State | PA
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Zip | 19050
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Country | US
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Telephone | 484-855-3142
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Fax |
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Provider Business Mailing Address
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Address Line | 941 CHURCH LN
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City | LANSDOWNE
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State | PA
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Zip | 19050-3725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MICHELLE CUTTINO
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Credential | NP
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Telephone | 484-855-3142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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