Provider Demographics
NPI:1790453066
Name:TRAVALINE, AMY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:TRAVALINE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ZAWADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:125 S 9TH ST STE 1005
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5123
Mailing Address - Country:US
Mailing Address - Phone:215-543-7002
Mailing Address - Fax:215-987-5891
Practice Address - Street 1:125 S 9TH ST STE 1005
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5123
Practice Address - Country:US
Practice Address - Phone:215-543-7002
Practice Address - Fax:215-987-5891
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO23855363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health