Provider Demographics
NPI:1639784713
Name:MASCARO, DANZELEEN MOTIL (CRNP)
Entity Type:Individual
Prefix:
First Name:DANZELEEN
Middle Name:MOTIL
Last Name:MASCARO
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 1:3031 WALTON RD STE C101
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2369
Mailing Address - Country:US
Mailing Address - Phone:610-825-3500
Mailing Address - Fax:610-825-8502
Practice Address - Street 1:3031 WALTON RD STE C101
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2369
Practice Address - Country:US
Practice Address - Phone:610-825-3500
Practice Address - Fax:610-825-8502
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022483363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics