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General NPI Number Information
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NPI Number | 1083963862
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Entity Type | Individual
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Provider Name | JESSICA R STEFANIC CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 12/19/2020
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Provider Practice Location Address
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Address Line | 4310 LONDONDERRY RD STE 202
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City | HARRISBURG
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State | PA
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Zip | 17109-5329
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Country | US
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Telephone | 717-791-2520
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Fax | 717-920-4361
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Provider Business Mailing Address
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Address Line | 409 S 2ND ST STE 2F
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City | HARRISBURG
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State | PA
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Zip | 17104-1612
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Country | US
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Telephone | 717-791-2520
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Fax | 717-703-0061
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN56548
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP012546
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP012546
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License Number State | PA
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