Healthcare Provider Details

I. General information

NPI: 1700940012
Provider Name (Legal Business Name): JEAN A YUDIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN GLASSER YUDIN CRNP

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 CHESTNUT ST RALSTON-PENN CENTER
PHILADELPHIA PA
19104-2612
US

IV. Provider business mailing address

3615 CHESTNUT ST RALSTON-PENN CENTER
PHILADELPHIA PA
19104-2612
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2746
  • Fax:
Mailing address:
  • Phone: 215-662-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberVP001574H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: