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General NPI Number Information
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NPI Number | 1285191197
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Entity Type | Individual
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Provider Name | JOELLE M MAFOUOTI CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 120 BURRUS BLVD STE 200
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-7812
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Country | US
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Telephone | 570-420-6300
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Fax | 570-402-2920
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Provider Business Mailing Address
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Address Line | 2501 W LEHIGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19132-3207
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Country | US
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Telephone | 215-227-0300
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Fax | 215-227-0302
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP020030
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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 | SP020022
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License Number State | PA
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