Healthcare Provider Details

I. General information

NPI: 1346290038
Provider Name (Legal Business Name): JOELLEN GITTENS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 JEFFERSON AVE SUITE 206
SCRANTON PA
18510-1635
US

IV. Provider business mailing address

743 JEFFERSON AVE SUITE 206
SCRANTON PA
18510-1635
US

V. Phone/Fax

Practice location:
  • Phone: 570-341-9818
  • Fax: 570-341-9950
Mailing address:
  • Phone: 570-341-9818
  • Fax: 570-341-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberUP003033C
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN232769L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberUP003033C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: