MEDICARE: NANCY LEAHY 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	363LA2200X	Adult Health Nurse Practitioner	SP-005701-C	PA

General Provider Information

NPI Number	:	1639170061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LEAHY CRNP

Provider Business Mailing Address
First Line	:	101 E OLNEY AVE
Second Line	:	SUITE 505
City	:	PHILA
State	:	PA
Zip	:	19120-2421
Country	:	US
Telephone Number	:	215-456-7000
Fax Number	:	215-254-2599

Provider Business Practice Location Address
First Line	:	5501 OLD YORK RD
Second Line	:	BRAEMER BLDG 2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-3018
Country	:	US
Telephone Number	:	215-456-3880
Fax Number	:	215-456-3437

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/19/2010

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