Healthcare Provider Details

I. General information

NPI: 1184137168
Provider Name (Legal Business Name): JALEESA RANAE JULES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JALEESA RANAE ANDRADE CRNP

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST FL 4
YORK PA
17403-3676
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-4005
  • Fax: 717-812-2495
Mailing address:
  • Phone: 177-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018122
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: