Basic Information
| Provider Information | |||||||||
| NPI: | 1114346194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHARAZI | ||||||||
| FirstName: | ILONA | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 174 COMMONWEALTH DR | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189402317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2672426213 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 TOWNSHIP LINE RD | ||||||||
| Address2: | |||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190272249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155725200 | ||||||||
| FaxNumber: | 2155726456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2014 | ||||||||
| LastUpdateDate: | 12/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | SP013660 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.