Provider Demographics
NPI:1245628486
Name:GAVIN, AILEEN PATRICIA (CRNP)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:PATRICIA
Last Name:GAVIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:RUETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 KING OF PRUSSIA ROAD
Mailing Address - Street 2:SUITE 301 NORTH
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4557
Mailing Address - Country:US
Mailing Address - Phone:610-902-2450
Mailing Address - Fax:610-902-2466
Practice Address - Street 1:145 KING OF PRUSSIA ROAD
Practice Address - Street 2:SUITE 301 NORTH
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4557
Practice Address - Country:US
Practice Address - Phone:610-902-2450
Practice Address - Fax:610-902-2466
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily