Provider Demographics
NPI:1659452001
Name:RAPHAEL, ELLEN GIBSON (RN-C, CRNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:GIBSON
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:RN-C, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 LARUE LN
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2213
Mailing Address - Country:US
Mailing Address - Phone:215-343-1434
Mailing Address - Fax:215-491-9135
Practice Address - Street 1:610 LOUIS DR
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2828
Practice Address - Country:US
Practice Address - Phone:215-957-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP001360G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health