MEDICARE: MS. JEAN MARIE PELLEGRINO CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP024897	PA

General Provider Information

NPI Number	:	1235330838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN MARIE PELLEGRINO CRNP

Provider Business Mailing Address
First Line	:	8118 OLD YORK RD STE D
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1423
Country	:	US
Telephone Number	:	215-635-3151
Fax Number	:	215-635-3165

Provider Business Practice Location Address
First Line	:	8118 OLD YORK RD STE D
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1423
Country	:	US
Telephone Number	:	215-635-3151
Fax Number	:	215-635-3165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	12/13/2021

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