Healthcare Provider Details

I. General information

NPI: 1003056888
Provider Name (Legal Business Name): JACQUELINE DESIREE JOSEPH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7164 ROUTE 209
STROUDSBURG PA
18360-7108
US

IV. Provider business mailing address

306 S NEW ST STE 110
BETHLEHEM PA
18015-1110
US

V. Phone/Fax

Practice location:
  • Phone: 570-656-4254
  • Fax: 570-300-9204
Mailing address:
  • Phone: 570-656-4254
  • Fax: 570-300-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP024568
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5727171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: