=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851703508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE CATHERINE METZ MSN, CRNP, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2014
-----------------------------------------------------
Last Update Date | 03/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4190 CITY AVE STE 528
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19131-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-849-7700
-----------------------------------------------------
Fax | 844-734-7689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23181 VERDUGO DR STE 103A
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-1313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-366-1053
-----------------------------------------------------
Fax | 844-734-7689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP013538
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------