Provider Demographics
NPI:1013441906
Name:NICOLAS, CHRISLINE (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISLINE
Middle Name:
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 EXTON SQUARE PKWY
Mailing Address - Street 2:UNIT 1417
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-5047
Mailing Address - Country:US
Mailing Address - Phone:484-274-7585
Mailing Address - Fax:
Practice Address - Street 1:7101 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126
Practice Address - Country:US
Practice Address - Phone:610-584-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner