Provider Demographics
NPI:1700829314
Name:OSTICK, MARY AGNES (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY AGNES
Middle Name:
Last Name:OSTICK
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 1:412 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1619
Mailing Address - Country:US
Mailing Address - Phone:610-446-4736
Mailing Address - Fax:
Practice Address - Street 1:800 LANCASTER AVE
Practice Address - Street 2:VILLAVNOA UNIVERSITY
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1603
Practice Address - Country:US
Practice Address - Phone:610-519-4070
Practice Address - Fax:610-519-4047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363LF0000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA36OtherNURSE PRACTITIONER