Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP011375 | PA |
NPI | 1003161860 |
---|---|
Provider Name | Mr. Charles E Warrington JR. |
First Address | Philadelphia, PA 19107-4824 |
Second Address | Philadelphia, PA 19107-4944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2012 |
Last Update Date | 07/10/2015 |