Provider Demographics
NPI:1558509430
Name:MENKIN, DANE ELLIOT (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DANE
Middle Name:ELLIOT
Last Name:MENKIN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S BRYN MAWR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3129
Mailing Address - Country:US
Mailing Address - Phone:610-325-1390
Mailing Address - Fax:610-325-1373
Practice Address - Street 1:135 S BRYN MAWR AVE STE 200
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3129
Practice Address - Country:US
Practice Address - Phone:610-325-1390
Practice Address - Fax:610-325-1373
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily