Patricia Wallace Belancio, CRNP

Individual provider Active NPI Adult Health Nurse Practitioner · Flourtown, PA

NPI 1700148459 · NPPES record last updated Jun 8, 2012

Key facts

NPI: 1700148459
Entity type: Individual (NPI type 1)
Primary specialty: Adult Health Nurse Practitioner 363LA2200X
License: SP011629 (PA)
Practice address: 1722 Bethlehem Pike
Flourtown, PA 19031-1644
Phone: (215) 233-9700
Fax: (215) 233-9710
NPI assigned: Jun 8, 2012
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Temple Physicians Inc Obstetrics & Gynecology Physician · Philadelphia, PA · NPI 1033471982

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
SP011629	PA	MD	Adult Health Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Temple Physicians Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Adult Health Nurse Practitioner	363LA2200X	SP011629	PA	Yes

Addresses

Primary practice location

1722 Bethlehem Pike
Flourtown, PA 19031-1644

Mailing address

PO Box 820933
Philadelphia, PA 19182-0933
Phone (215) 926-9010

Other identifiers

Identifier	Type	State	Issuer
100727800	Other	PA	MEDICAID TPI GROUP
597586	Other	PA	MEDICARE TPI GROUP
CD4829	Other	PA	RAILROAD MEDICARE TPI GROUP

Other names

Patricia Dolores Wallace Former name

Other providers in Flourtown, PA

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Laura A Baker, M.ED
Laurie B. Baker, M.S.W., L.C.S.W.
Bariatric Medicine Institute
Madison Bear, LSW
Nancy Belser, MD
Laura C Beringer, CRNP
Charles H Blonstein, PHD
Raphael T Bloomgarden, M.D.
Bonavitacola Psychological Services, LLC

All providers in Flourtown, PA · Adult Health Nurse Practitioner in Pennsylvania

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.