=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992847685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLENE POKRYWKA-MCALEER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 BARCLAY ST
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-860-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 CANTERBURY LN
-----------------------------------------------------
City | HORSHAM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19044-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-659-0512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | TP006029M
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------