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NPI Code Detail

MEDICARE: DENISE CARR

MEDICARE: DENISE CARR
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
1363LP0200XPediatric Nurse PractitionerSP013141PA

General Provider Information

NPI Number : 1639504434
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE CARR
Provider Business Mailing Address
First Line : 6608 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2120
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6608 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2120
Country : US
Telephone Number : 610-622-2129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2013
Last Update Date : 12/22/2013

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