Provider Demographics
NPI:1790203669
Name:DREXEL UNIVERSITY
Entity Type:Organization
Organization Name:DREXEL UNIVERSITY
Other - Org Name:DREXEL CNHP NURSE PRACTITIONER FACULTY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-255-7822
Mailing Address - Street 1:1601 CHERRY ST STE 11511
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1310
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:1601 CHERRY ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1306
Practice Address - Country:US
Practice Address - Phone:215-255-7822
Practice Address - Fax:215-255-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty