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General NPI Number Information
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NPI Number | 1417311226
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Entity Type | Individual
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Provider Name | DEBORAH ANN STALLWORTH
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Gender | Female
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 821 E UPSAL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1542
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Country | US
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Telephone | 215-764-9679
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Fax |
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Provider Business Mailing Address
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Address Line | 821 E UPSAL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1542
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Country | US
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Telephone | 215-844-4278
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP013407
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License Number State | PA
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