Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS015265 | PA |
N | 103G00000X | Clinical Psychologist | PS015265 | PA |
N | 103TC0700X | Clinical Psychologist | PS015265 | PA |
N | 363L00000X | Nurse Practitioner | SP007233 | PA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | SP007233 | PA |
NPI | 1407969793 |
---|---|
Provider Name | Miss Nina M. Chychula |
First Address | Philadelphia, PA 19115-2507 |
Second Address | Philadelphia, PA 19104-4551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |