Provider Demographics
NPI:1184719924
Name:KINNIRY, JOAN H (CRNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:H
Last Name:KINNIRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:G
Other - Last Name:HOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3958
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:9 FOUNDERS, MICU
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ38496Medicare UPIN
PA088592Medicare ID - Type Unspecified