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General NPI Number Information
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NPI Number | 1053011775
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Entity Type | Individual
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Provider Name | JESSICA LYNNE SMITH RN
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Gender | Female
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 21 BUTTERNUT DR
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City | HATBORO
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State | PA
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Zip | 19040-1513
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Country | US
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Telephone | 215-920-1789
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Fax |
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | RN585570
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License Number State | PA
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