Healthcare Provider Details

I. General information

NPI: 1033591573
Provider Name (Legal Business Name): ELLEN JESSE BERNSTEIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2015
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 370
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

3400 SPRUCE ST 3RD FLR SILVERSTEIN
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-3005
  • Fax: 610-642-3057
Mailing address:
  • Phone: 215-662-3487
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014695
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: