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General NPI Number Information
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NPI Number | 1619228376
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Entity Type | Individual
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Provider Name | KALYCA LEYANA DUBOSE ACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 213 REECEVILLE RD SUITE 27
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City | COATESVILLE
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State | PA
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Zip | 19320-1528
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Country | US
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Telephone | 610-383-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 902 PAINTERS XING
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City | CHADDS FORD
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State | PA
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Zip | 19317-9631
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Country | US
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Telephone | 484-574-8036
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP012373
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License Number State | PA
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