Basic Information
Provider Information
NPI: 1356424022
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TODD
FirstName: BARBARA
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3400 SPRUCE ST
Address2: 4 SILVERSTEIN BUILDING
City: PHILADELPHIA
State: PA
PostalCode: 191044206
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3400 SPRUCE ST
Address2: 4 SILVERSTEIN BUILDING
City: PHILADELPHIA
State: PA
PostalCode: 191044206
CountryCode: US
TelephoneNumber: 2156622050
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/24/2006
LastUpdateDate: 04/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XVP000922BPAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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