Provider Demographics
NPI:1710284641
Name:MARKHAM, ANNE M (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:K
Other - Last Name:MALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:SUITE 320A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:215-955-8874
Mailing Address - Fax:215-503-7762
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:SUITE 220A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:215-955-8874
Practice Address - Fax:215-503-7762
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005373C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102903540Medicaid
PA264327Medicare PIN
PA102903540Medicaid