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General NPI Number Information
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NPI Number | 1336389030
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Entity Type | Individual
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Provider Name | JILL MELISSA BREGOVI RN, MSN, CPNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 34TH STREET AND CIVIC CENTER BOULEVARD WOOD CENTER DIVISION OF UROLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4399
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Country | US
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Telephone | 215-590-5754
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Fax |
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Provider Business Mailing Address
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Address Line | 34TH STREET AND CIVIC CENTER BOULEVARD WOOD CENTER DIVISION OF UROLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4399
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Country | US
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Telephone | 215-590-5754
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | SP010209
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License Number State | PA
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