Provider Demographics
NPI:1396705604
Name:ROONEY, JOAN (RN/CRNP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:ROONEY
Suffix:
Gender:F
Credentials:RN/CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 MARYLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1709
Mailing Address - Country:US
Mailing Address - Phone:215-657-6776
Mailing Address - Fax:267-913-5964
Practice Address - Street 1:2360 MARYLAND RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1709
Practice Address - Country:US
Practice Address - Phone:215-657-6776
Practice Address - Fax:267-913-5961
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004371C363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P42314Medicare UPIN