Provider Demographics
NPI:1861680589
Name:REARDON, ANN MARIE (CPNP)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:REARDON
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA - EMERGENCY MED
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1944
Practice Address - Fax:215-590-4454
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2013-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAVP002240D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics