MEDICARE: IRINA NURSE PRACTITIONER, LLC.

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1285581793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRINA NURSE PRACTITIONER, LLC.

Provider Business Mailing Address
First Line	:	9867 BUSTLETON AVE STE B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9867 BUSTLETON AVE STE B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2600
Country	:	US
Telephone Number	:	267-516-7746
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IRINA EFRAIMOVICH
Credential	:
Telephone Number	:	267-516-7746

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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