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General NPI Number Information
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NPI Number | 1861999542
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Entity Type | Individual
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Provider Name | BASHIRA CHARLES PHD, RN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 440 NORTH BROAD STREET STUDENT HEALTH SERVICES
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City | PHILADELPHIA
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State | PA
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Zip | 10130-4015
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Country | US
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Telephone | 215-400-5704
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Fax | 215-400-4173
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Provider Business Mailing Address
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Address Line | 738 LANDIS ST
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City | PHILADELPHIA
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State | PA
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Zip | 19124-3011
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Country | US
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Telephone | 215-225-0325
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Fax | 215-400-4173
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | SP008021
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License Number State | PA
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