Healthcare Provider Details

I. General information

NPI: 1235897398
Provider Name (Legal Business Name): JENNIFER ANN MCGEEHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 POLLOCK ST APT 2
PHILADELPHIA PA
19145-4822
US

IV. Provider business mailing address

1825 POLLOCK ST APT 2
PHILADELPHIA PA
19145-4822
US

V. Phone/Fax

Practice location:
  • Phone: 215-767-7418
  • Fax: 215-860-2703
Mailing address:
  • Phone: 215-767-7418
  • Fax: 215-860-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: