MEDICARE: ROSANNA POLLACK CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	TP004579N	PA

General Provider Information

NPI Number	:	1184637217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSANNA POLLACK CRNP

Provider Business Mailing Address
First Line	:	40 HUCKLEBERRY WAY
Second Line	:
City	:	TURNERSVILLE
State	:	NJ
Zip	:	08012-5816
Country	:	US
Telephone Number	:	856-290-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 CIVIC CENTER BLVD
Second Line	:	4TH FLOOR WOOD BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4302
Country	:	US
Telephone Number	:	215-590-4953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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