Provider Demographics
NPI:1639716640
Name:PATEL, PRIYANKA B (CRNP)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 13TH ST APT 1206
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5464
Mailing Address - Country:US
Mailing Address - Phone:267-207-9972
Mailing Address - Fax:
Practice Address - Street 1:201 S 13TH ST APT 1206
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5464
Practice Address - Country:US
Practice Address - Phone:267-207-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily