Healthcare Provider Details

I. General information

NPI: 1295019552
Provider Name (Legal Business Name): PAMELA ANN REYNOLDS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA ANN JURASH

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 HADDONFIELD BERLIN RD
CHERRY HILL NJ
08003-3736
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10, SUITE 320
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-3313
  • Fax: 888-898-2615
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN09518500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NN09518500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: