=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417829714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANA LEE CHURCHILL AGNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2025
-----------------------------------------------------
Last Update Date | 09/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 BETHLEHEM PIKE FL 1
-----------------------------------------------------
City | ERDENHEIM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-248-1350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 906 BETHLEHEM PIKE FL 1
-----------------------------------------------------
City | ERDENHEIM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-248-1350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | SP033621
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------