Healthcare Provider Details

I. General information

NPI: 1831409226
Provider Name (Legal Business Name): JACQUELINE L ZIPAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE L GRAFTON CRNP

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD. 4TH FLOOR - PERELMAN WEST
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD. 4TH FLOOR - PERELMAN WEST
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-7500
  • Fax: 215-592-6588
Mailing address:
  • Phone: 215-615-7500
  • Fax: 215-592-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP010866
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: