Healthcare Provider Details

I. General information

NPI: 1417529116
Provider Name (Legal Business Name): LIZA NATASHA JAINARINE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE BLDG N
WEST READING PA
19611-2143
US

IV. Provider business mailing address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2497
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-0900
  • Fax:
Mailing address:
  • Phone: 215-214-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN524952L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024246
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: