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General NPI Number Information
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NPI Number | 1790721066
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Entity Type | Individual
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Provider Name | BLANCA LUGO MARTIR CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9501 ROOSEVELT BLVD SUITE 305
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1025
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Country | US
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Telephone | 215-671-4280
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Fax | 215-464-9034
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Provider Business Mailing Address
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Address Line | 9501 ROOSEVELT BLVD SUITE 305
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1025
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Country | US
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Telephone | 215-671-4280
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Fax | 215-464-9034
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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 | VP006234C
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License Number State | PA
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