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General NPI Number Information
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NPI Number | 1003056888
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Entity Type | Individual
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Provider Name | JACQUELINE DESIREE JOSEPH CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 306 S NEW ST STE 110
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City | BETHLEHEM
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State | PA
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Zip | 18015-1110
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Country | US
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Telephone | 610-708-5752
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Fax | 570-300-9204
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Provider Business Mailing Address
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Address Line | 306 S NEW ST STE 110
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City | BETHLEHEM
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State | PA
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Zip | 18015-1110
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Country | US
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Telephone | 610-708-5752
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Fax | 570-300-9204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP024568
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 5727171
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License Number State | NY
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