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General NPI Number Information
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NPI Number | 1992030845
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Entity Type | Individual
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Provider Name | MARYLOU MACDERMOTT CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 3400 CIVIC CENTER BLVD THE CHILDREN'S HOSPITAL FOR CHILDREN
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-590-6539
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Fax |
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Provider Business Mailing Address
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Address Line | 37 COOPER ST
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City | HADDON TOWNSHIP
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State | NJ
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Zip | 08108-2351
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Country | US
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Telephone | 856-240-1854
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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 | SP002261N
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License Number State | PA
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