Provider Demographics
NPI:1366187569
Name:NURSE VAX PHILLY LLC
Entity type:Organization
Organization Name:NURSE VAX PHILLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBTRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEREBEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-701-3970
Mailing Address - Street 1:7153 TORRESDALE AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135
Mailing Address - Country:US
Mailing Address - Phone:215-701-3970
Mailing Address - Fax:
Practice Address - Street 1:7153 TORRESDALE AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135
Practice Address - Country:US
Practice Address - Phone:215-701-3970
Practice Address - Fax:215-703-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care