=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356761324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH ANNE CRUZ CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2014
-----------------------------------------------------
Last Update Date | 04/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 S 11TH ST 1252 THOMPSON BUILDING
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-4824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-7833
-----------------------------------------------------
Fax | 215-923-3608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 STREET. 11TH STREET. 1252 THOMPSON BUILDING JEFFERSON UNIVERSITY HOSPITAL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-7833
-----------------------------------------------------
Fax | 215-923-3608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP1700X
-----------------------------------------------------
Taxonomy Name | Perinatal Nurse Practitioner
-----------------------------------------------------
License Number | VP003519T
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------