Healthcare Provider Details

I. General information

NPI: 1902143555
Provider Name (Legal Business Name): JESSICA ANNE LORD C. R.N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E BROWN ST
EAST STROUDSBURG PA
18301-3006
US

IV. Provider business mailing address

206 E BROWN ST POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
EAST STROUDSBURG PA
18301-3006
US

V. Phone/Fax

Practice location:
  • Phone: 570-476-3700
  • Fax: 570-476-3637
Mailing address:
  • Phone: 570-420-4951
  • Fax: 570-476-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN595830
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: