Healthcare Provider Details

I. General information

NPI: 1093176505
Provider Name (Legal Business Name): JILL GEBERT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE
WYNNEWOOD PA
19096
US

IV. Provider business mailing address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 484-476-1000
  • Fax: 484-476-9000
Mailing address:
  • Phone: 484-476-1000
  • Fax: 484-476-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: