Provider Demographics
NPI:1366073728
Name:BACHMAN, NACKEA ROSE (PA)
Entity type:Individual
Prefix:MISS
First Name:NACKEA
Middle Name:ROSE
Last Name:BACHMAN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1237 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3469
Mailing Address - Country:US
Mailing Address - Phone:215-769-3561
Mailing Address - Fax:215-232-1785
Practice Address - Street 1:1237 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3469
Practice Address - Country:US
Practice Address - Phone:215-769-3561
Practice Address - Fax:215-232-1785
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2023-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA061627363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical