Healthcare Provider Details

I. General information

NPI: 1265492136
Provider Name (Legal Business Name): MONIKA JELIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W SOMERSET ST
PHILADELPHIA PA
19133-3534
US

IV. Provider business mailing address

260 S BROAD ST
PHILADELPHIA PA
19102-5021
US

V. Phone/Fax

Practice location:
  • Phone: 267-765-2272
  • Fax: 215-426-5123
Mailing address:
  • Phone: 215-985-2500
  • Fax: 267-765-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP009728
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: