MEDICARE: KIMBERLY DEHNKAMP 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	363LF0000X	Family Nurse Practitioner	SP008022	PA

General Provider Information

NPI Number	:	1720317126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DEHNKAMP CRNP

Provider Business Mailing Address
First Line	:	3401 N BROAD ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19140-5103
Country	:	US
Telephone Number	:	215-707-5483
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 N BROAD ST
Second Line	:	DEPT OF EMERGENCY MEDICINE
City	:	PHILA
State	:	PA
Zip	:	19140-5103
Country	:	US
Telephone Number	:	215-707-5483
Fax Number	:

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

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	12/14/2009

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