Provider Demographics
NPI:1528204898
Name:MCINTYRE, MARIE A (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:ARBUTINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:800 WALNUT ST
Mailing Address - Street 2:20TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5176
Mailing Address - Country:US
Mailing Address - Phone:215-829-8713
Mailing Address - Fax:215-829-5350
Practice Address - Street 1:700 SPRUCE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4022
Practice Address - Country:US
Practice Address - Phone:215-829-3697
Practice Address - Fax:215-829-8451
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010089363LA2200X
PASP010622363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology