Healthcare Provider Details

I. General information

NPI: 1336431402
Provider Name (Legal Business Name): JENNIFER K HARE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W STATE ST
DOYLESTOWN PA
18901-2554
US

IV. Provider business mailing address

PO BOX 829641
PHILADELPHIA PA
19182-9641
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-2100
  • Fax: 215-345-2110
Mailing address:
  • Phone: 267-893-6800
  • Fax: 267-893-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP010998
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: