Basic Information
Provider Information
NPI: 1487820015
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FIGUEROA
FirstName: JUANITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MSN, CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4700 WISSAHICKON AVE
Address2: SUITE 118
City: PHILADELPHIA
State: PA
PostalCode: 191444248
CountryCode: US
TelephoneNumber: 2675973600
FaxNumber: 2675973622
Practice Location
Address1: 850 N 11TH ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191231957
CountryCode: US
TelephoneNumber: 2157691100
FaxNumber: 2157691117
Other Information
ProviderEnumerationDate: 05/04/2008
LastUpdateDate: 04/22/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XVP05501BPAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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