Healthcare Provider Details

I. General information

NPI: 1548242209
Provider Name (Legal Business Name): JENNIFER A WARDLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA AVE
LANCASTER PA
17603-4154
US

IV. Provider business mailing address

2301 COLUMBIA AVE
LANCASTER PA
17603-4154
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-2738
  • Fax: 717-397-7634
Mailing address:
  • Phone: 717-397-2738
  • Fax: 717-397-7634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP-005833-B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: