Healthcare Provider Details

I. General information

NPI: 1730555814
Provider Name (Legal Business Name): HEE WON JEONG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S 9TH ST
PHILADELPHIA PA
19107-5125
US

IV. Provider business mailing address

1030 EAST LANCASTER AVENUE #1019
BRYN MAWR PA
19010-1446
US

V. Phone/Fax

Practice location:
  • Phone: 215-592-4500
  • Fax:
Mailing address:
  • Phone: 267-272-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014617
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025261
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN604883
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: