Provider Demographics
NPI:1144698408
Name:NWANERI, RAYMOND C (DNP, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:C
Last Name:NWANERI
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3301 SCOTTS LANE
Mailing Address - Street 2:HAVEN BEHAVIORAL HOSPITAL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129
Mailing Address - Country:US
Mailing Address - Phone:856-304-2601
Mailing Address - Fax:
Practice Address - Street 1:3301 SCOTTS LANE
Practice Address - Street 2:HAVEN BEHAVIORAL HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129
Practice Address - Country:US
Practice Address - Phone:856-304-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP 013851363LG0600X
PASP013851363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology