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General NPI Number Information
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NPI Number | 1306192182
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Entity Type | Individual
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Provider Name | LOVELY SIJJU VARGHESE CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 850 PAPER MILL RD FAIRVIEW CARE CENTER OF PAPER MILL
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City | GLENSIDE
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State | PA
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Zip | 19038-7833
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Country | US
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Telephone | 215-233-0920
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Fax | 215-673-1894
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Provider Business Mailing Address
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Address Line | 850 PAPER MILL RD FAIRVIEW CARE CENTER OF PAPER MILL ROAD
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City | GLENSIDE
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State | PA
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Zip | 19038-7833
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Country | US
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Telephone | 215-233-0920
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Fax | 215-673-1894
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP012066
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License Number State | PA
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