Provider Demographics
NPI:1962507020
Name:PRENTICE, THERESE CROWLEY (APN)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:CROWLEY
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:5 TOLL
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:215-481-4100
Mailing Address - Fax:215-481-4199
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:5 TOLL
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-4100
Practice Address - Fax:215-481-4199
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07978900363L00000X
PASP001514C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0288543Medicaid
NJ0288543Medicaid
NJ236872Medicare PIN