Provider Demographics
NPI:1336618529
Name:RADICE, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RADICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BERKLEY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1381
Mailing Address - Country:US
Mailing Address - Phone:215-237-1796
Mailing Address - Fax:
Practice Address - Street 1:45 BERKLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1381
Practice Address - Country:US
Practice Address - Phone:215-237-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000716171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist