NPI 1396693909 · live from the CMS NPI Registry
A Fulfilling Life
Registered Nurse, General Practice in Philadelphia, PA. National Provider Identifier 1396693909, active.
NPI record
| NPI | 1396693909 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Registered Nurse, General Practice 163WG0000X |
| Practice location | 3000 W Master St Apt 408, Philadelphia, PA 19121 |
| Practice phone | 215-416-8664 |
| Enumerated | March 19, 2026 |
| Last updated | March 19, 2026 |
| Authorized official | Kenya Reed, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Licensed Practical Nurse | 164W00000X | — |
| Registered Nurse, General Practice primary | 163WG0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.