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General NPI Number Information
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NPI Number | 1710853502
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Entity Type | Organization
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Legal Business Name | MAPLE MEDICAL AND WELLNESS
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 4612 ASHBURNER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19136-2810
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Country | US
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Telephone | 267-901-8359
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Fax |
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Provider Business Mailing Address
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Address Line | 4612 ASHBURNER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19136-2810
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Country | US
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Telephone | 267-901-8359
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. VANESSA EXAMA MOLIN
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Credential | CRNP
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Telephone | 267-901-8359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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