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General NPI Number Information
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NPI Number | 1295361160
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Entity Type | Individual
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Provider Name | JACQUELYN YVETTE HARTER CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 160 E ERIE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-1011
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Country | US
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Telephone | 215-427-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 940 MAPLE AVE
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City | COLLINGSWOOD
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State | NJ
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Zip | 08108-2044
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Country | US
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Telephone | 609-802-4370
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP021687
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License Number State | PA
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