Provider Demographics
NPI:1528238763
Name:KAUFMAN, FERN MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:FERN
Middle Name:MICHELLE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:FERN
Other - Middle Name:MICHELLE
Other - Last Name:KAMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:PHI 2C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-9010
Mailing Address - Fax:
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:PHI - 2C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009731363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care