Healthcare Provider Details

I. General information

NPI: 1023882537
Provider Name (Legal Business Name): JAMILA GUMMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2884 HODLE AVE
EASTON PA
18045-8101
US

IV. Provider business mailing address

2884 HODLE AVE
EASTON PA
18045-8101
US

V. Phone/Fax

Practice location:
  • Phone: 161-078-1981
  • Fax:
Mailing address:
  • Phone: 610-781-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15369400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP028427
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: