Healthcare Provider Details

I. General information

NPI: 1194378505
Provider Name (Legal Business Name): JACQUELINE GLANFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534
US

IV. Provider business mailing address

3 PETER GAMBLE LN
GLEN MILLS PA
19342-1230
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-6000
  • Fax:
Mailing address:
  • Phone: 610-787-2579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: