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General NPI Number Information
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NPI Number | 1972197069
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Entity Type | Individual
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Provider Name | NICOLE MARIE BASSOUNAS CRNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 925 CHESTNUT ST STE 220A
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4248
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Country | US
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Telephone | 215-955-8874
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 PINE ST APT 3F
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4643
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Country | US
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Telephone | 717-649-3255
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP023004
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License Number State | PA
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