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General NPI Number Information
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NPI Number | 1891116828
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Entity Type | Individual
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Provider Name | KELLY C LOSCALZO CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 1991 SPROUL RD SUITE 600 LAWRENCE PARK CENTER
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City | BROOMALL
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State | PA
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Zip | 19008-3512
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Country | US
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Telephone | 610-325-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 928 S 2ND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-4203
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | SP 013391
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License Number State | PA
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