Provider Demographics
NPI:1013315670
Name:GHORASHI, MEHRNAZ (NP)
Entity Type:Individual
Prefix:
First Name:MEHRNAZ
Middle Name:
Last Name:GHORASHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 LOCUST ST
Mailing Address - Street 2:APT 425
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5252
Mailing Address - Country:US
Mailing Address - Phone:240-920-9637
Mailing Address - Fax:
Practice Address - Street 1:4247 LOCUST ST
Practice Address - Street 2:APT 425
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5252
Practice Address - Country:US
Practice Address - Phone:240-920-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner