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General NPI Number Information
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NPI Number | 1225863905
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Entity Type | Individual
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Provider Name | JULIA REGER CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 3737 MARKET STREET 8TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5501
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Country | US
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Telephone | 484-326-8511
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 CIVIC CENTER BLVD 15TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5127
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Country | US
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Telephone | 484-326-8511
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP030410
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License Number State | PA
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