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General NPI Number Information
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NPI Number | 1124730791
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Entity Type | Individual
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Provider Name | SHANERHA TATE CRNP, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 5800 WALNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3836
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Country | US
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Telephone | 215-474-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 504 S LANSDOWNE AVE APT E7
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City | LANSDOWNE
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State | PA
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Zip | 19050-2427
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Country | US
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Telephone | 267-368-0063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | SP026420
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License Number State | PA
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