MEDICARE: DANIELLE NICOLE ALTARES 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	SP011741	PA

General Provider Information

NPI Number	:	1790062172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE NICOLE ALTARES CRNP

Provider Business Mailing Address
First Line	:	2510 MARYLAND RD STE 160
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1137
Country	:	US
Telephone Number	:	215-672-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 MARYLAND RD STE 160
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1137
Country	:	US
Telephone Number	:	215-672-6622
Fax Number	:

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

Provider Enumeration Date	:	11/13/2011
Last Update Date	:	12/04/2011

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