Healthcare Provider Details

I. General information

NPI: 1407564248
Provider Name (Legal Business Name): JENNA VAUGHAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E BUTLER AVE STE 201
NEW BRITAIN PA
18901-5219
US

IV. Provider business mailing address

65 E BUTLER AVE STE 201
NEW BRITAIN PA
18901-5219
US

V. Phone/Fax

Practice location:
  • Phone: 215-822-3113
  • Fax: 215-822-0889
Mailing address:
  • Phone: 215-822-3113
  • Fax: 215-822-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP026559
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: