Healthcare Provider Details

I. General information

NPI: 1912603853
Provider Name (Legal Business Name): JESSICA R CANTOR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HIGHLANDS DR STE 205
LITITZ PA
17543-7507
US

IV. Provider business mailing address

1575 HIGHLANDS DR STE 101
LITITZ PA
17543-7507
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-1338
  • Fax: 717-627-1817
Mailing address:
  • Phone: 717-393-1338
  • Fax: 717-627-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: