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General NPI Number Information
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NPI Number | 1497519292
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Entity Type | Individual
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Provider Name | JACQUELYN COURIM DNP
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Gender | Female
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 5607 ROUTE 957
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City | RUSSELL
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State | PA
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Zip | 16345-2033
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Country | US
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Telephone | 814-593-0011
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Fax | 814-593-0012
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Provider Business Mailing Address
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Address Line | 5607 ROUTE 957
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City | RUSSELL
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State | PA
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Zip | 16345-2033
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Country | US
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Telephone | 814-593-0011
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Fax | 814-593-0012
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SPO27894
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License Number State | PA
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