Doctor Name: | MRS. MARY AGNES OSTICK |
NPI Number: | 1700829314 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 363LF0000X |
Business Practice Address: | 800 Lancaster Ave Villavnoa University Villanova, PA - 190851603 |
Business Phone Number: | 6105194070 |
Business Fax Number: | 6105194047 |
Mailing Address: | 412 Cherry Ln, HAVERTOWN |
State: | PA |
Postal Code: | 190831619 |
Phone Number: | 6104464736 |
Fax Number: | |
NPI Enumeration Date: | 06/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 363LF0000X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |