IndividualActive
Mary Udicious, CRNP
NPI 1124037296 · Adult Health Nurse Practitioner · Media, PA
Provider details
- NPI number
- 1124037296
- Entity type
- Individual
- Primary specialty
- Adult Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- CRNP
- Sex
- Female
- Sole proprietor
- Yes
- License
- SP009093 (PA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1088 W Baltimore Pike
Suite 2500
Media, PA 19063-5146
Phone: (610) 565-4107
Fax: (610) 565-8349
Street-level locationGet directions
Mailing address
1088 W Baltimore Pike
Media, PA 19063-5146
Registry dates
- Enumerated
- 2006-08-06
- Last updated
- 2010-06-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.