Provider Demographics
NPI:1871670323
Name:ECKEL, CAROLYN AZUBAH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:AZUBAH
Last Name:ECKEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1775 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4559
Mailing Address - Country:US
Mailing Address - Phone:215-355-5925
Mailing Address - Fax:215-785-4118
Practice Address - Street 1:721 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2506
Practice Address - Country:US
Practice Address - Phone:215-785-4597
Practice Address - Fax:215-785-4118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAVP004657B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily