Basic Information
| Provider Information | |||||||||
| NPI: | 1710976121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUATTRINI | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 SANSOM ST | ||||||||
| Address2: | STE 239 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556844 | ||||||||
| FaxNumber: | 2159552526 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 SANSOM ST | ||||||||
| Address2: | STE 239 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556844 | ||||||||
| FaxNumber: | 2159552526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R084503 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | SP009940 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | R084503 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 062203600 | 05 | MD | MEDICAID |