Provider Demographics
NPI:1093057879
Name:DISTLER, PEIWEN
Entity Type:Individual
Prefix:
First Name:PEIWEN
Middle Name:
Last Name:DISTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEIWEN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:680 BLAIR MILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2223
Mailing Address - Country:US
Mailing Address - Phone:223-322-1906
Mailing Address - Fax:844-589-4699
Practice Address - Street 1:680 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2223
Practice Address - Country:US
Practice Address - Phone:223-322-1906
Practice Address - Fax:844-589-4699
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012737363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care