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General NPI Number Information
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NPI Number | 1508368994
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Entity Type | Individual
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Provider Name | KRYSHA PATRIZ MALLARI CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 595 E LANCASTER AVE
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City | ST DAVIDS
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State | PA
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Zip | 19087-5111
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Country | US
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Telephone | 215-645-5664
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Fax | 610-756-2045
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Provider Business Mailing Address
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Address Line | 834 CHESTNUT ST, STE 104
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 215-258-8301
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Fax | 610-756-2045
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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 | SP018407
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP018407
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP018407
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP018407
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License Number State | PA
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