Provider Demographics
NPI:1386028751
Name:WAKEMAN, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 GREEDY STREET
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19135
Mailing Address - Country:US
Mailing Address - Phone:267-949-7698
Mailing Address - Fax:
Practice Address - Street 1:4118 GREEBY ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19135-2517
Practice Address - Country:US
Practice Address - Phone:267-949-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006144B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner