Provider Demographics
NPI:1669413209
Name:GUTHRIE, MORTON R (CRNP)
Entity type:Individual
Prefix:
First Name:MORTON
Middle Name:R
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4405
Mailing Address - Country:US
Mailing Address - Phone:215-955-7190
Mailing Address - Fax:215-923-9186
Practice Address - Street 1:833 CHESTNUT STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4405
Practice Address - Country:US
Practice Address - Phone:215-955-7190
Practice Address - Fax:215-923-9186
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007649163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1863628OtherHIGHMARK BLUE SHIELD
PA102032PAGMedicare PIN
PA102032JL1Medicare PIN
PA1863628OtherHIGHMARK BLUE SHIELD