Provider Demographics
NPI:1548291594
Name:BEWICK, DARLENE MARIE (CRNP)
Entity type:Individual
Prefix:MISS
First Name:DARLENE
Middle Name:MARIE
Last Name:BEWICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-955-1000
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST STE 703
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4409
Practice Address - Country:US
Practice Address - Phone:215-955-1000
Practice Address - Fax:215-503-2066
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP-007741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103054705Medicaid
PA103054705Medicaid
Q52731Medicare UPIN