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General NPI Number Information
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NPI Number | 1386246288
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Entity Type | Individual
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Provider Name | NICOLE HARNWELL
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Gender | Female
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Dates
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Enumeration Date | 11/15/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1702 MELROSE AVE
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City | HAVERTOWN
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State | PA
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Zip | 19083-1916
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Country | US
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Telephone | 610-717-2433
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 MELROSE AVE
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City | HAVERTOWN
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State | PA
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Zip | 19083-1916
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Country | US
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Telephone | 610-717-2433
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA062153
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License Number State | PA
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