Provider Demographics
NPI:1659720290
Name:REDGUARD, ANNETTE (MSN, CRNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:REDGUARD
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 UNION MEETING RD
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1910
Mailing Address - Country:US
Mailing Address - Phone:856-288-9115
Mailing Address - Fax:
Practice Address - Street 1:1999 W HUNTING PARK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2828
Practice Address - Country:US
Practice Address - Phone:215-228-9300
Practice Address - Fax:215-228-9913
Is Sole Proprietor?:No
Enumeration Date:2016-06-04
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily