Healthcare Provider Details

I. General information

NPI: 1295443091
Provider Name (Legal Business Name): JENNIFER ARBISO-WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

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

1200 INTREPID AVE
PHILADELPHIA PA
19112-1229
US

IV. Provider business mailing address

58328 BONANZA DR
YUCCA VALLEY CA
92284-6209
US

V. Phone/Fax

Practice location:
  • Phone: 442-370-1580
  • Fax: 442-370-1580
Mailing address:
  • Phone: 442-370-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number951875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: