Provider Demographics
NPI:1649669508
Name:PSILLOS, ANNA (CRNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PSILLOS
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 1:5501 OLD YORK RD
Mailing Address - Street 2:KLEIN BLDG-331
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-8608
Mailing Address - Fax:215-456-7512
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:KORMAN BUILDING-SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-254-2612
Practice Address - Fax:215-456-7512
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP014068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner