Provider Demographics
NPI:1073941308
Name:STRATTON, DACEY BOINAIV (CRNP)
Entity Type:Individual
Prefix:
First Name:DACEY
Middle Name:BOINAIV
Last Name:STRATTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4525
Mailing Address - Country:US
Mailing Address - Phone:207-664-8738
Mailing Address - Fax:215-893-2251
Practice Address - Street 1:1700 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1529
Practice Address - Country:US
Practice Address - Phone:215-454-8000
Practice Address - Fax:215-893-2251
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013271363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health