Healthcare Provider Details

I. General information

NPI: 1760576557
Provider Name (Legal Business Name): JESSICA STROHM FARBER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH ST. & CIVIC CENTER BLVD. THE CHILDREN'S HOSPITAL OF PHILADELPHIA MAIN BUILDING
PHILADELPHIA PA
19104-4399
US

IV. Provider business mailing address

34TH STREET AND CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4318
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 215-590-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberUP006042O
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: