Healthcare Provider Details

I. General information

NPI: 1962549337
Provider Name (Legal Business Name): JENNIFER PETRUNIS BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N DELAWARE AVE STE 303
PHILADELPHIA PA
19123-4228
US

IV. Provider business mailing address

520 N DELAWARE AVE STE 303
PHILADELPHIA PA
19123-4228
US

V. Phone/Fax

Practice location:
  • Phone: 215-387-3223
  • Fax: 215-387-3203
Mailing address:
  • Phone: 215-387-3223
  • Fax: 215-387-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN702983
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: