Basic Information
| Provider Information | |||||||||
| NPI: | 1932556735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYABOKE | ||||||||
| FirstName: | CHRISTENE | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102728221 | ||||||||
| FaxNumber: | 6102725655 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102728221 | ||||||||
| FaxNumber: | 6102725655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2016 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | SP017043 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | SP017043 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.