Provider Demographics
NPI:1609538321
Name:MACALLISTER, EMMA LETT
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LETT
Last Name:MACALLISTER
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 1:230 W WASHINGTON SQ FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3500
Mailing Address - Country:US
Mailing Address - Phone:215-829-5064
Mailing Address - Fax:
Practice Address - Street 1:230 W WASHINGTON SQ FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:506-421-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN706174163W00000X
PASP024484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse