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General NPI Number Information
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NPI Number | 1689892333
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Entity Type | Individual
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Provider Name | ALIS K PANZERA CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 123 RIDGEFIELD RD
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-3812
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Country | US
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Telephone | 610-353-4391
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Fax | 610-356-2730
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Provider Business Mailing Address
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Address Line | 897 HERITAGE RD
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City | MOORESTOWN
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State | NJ
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Zip | 08057-1329
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Country | US
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Telephone | 856-727-0653
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP007092
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License Number State | PA
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