Provider Demographics
NPI:1811570112
Name:NURSES UNITED AGAINST COVID19
Entity Type:Organization
Organization Name:NURSES UNITED AGAINST COVID19
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAVEDA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:267-588-2328
Mailing Address - Street 1:5751 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1215
Mailing Address - Country:US
Mailing Address - Phone:267-254-9771
Mailing Address - Fax:215-382-5803
Practice Address - Street 1:3939 WARREN STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:267-254-9771
Practice Address - Fax:215-382-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP016107OtherCRNP LISENCE