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General NPI Number Information
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NPI Number | 1518080100
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Entity Type | Individual
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Provider Name | JENNIFER TANZOLA
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Gender | Female
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4150 REDBUD DR W
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City | WHITEHALL
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State | PA
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Zip | 18052-1952
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Country | US
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Telephone | 610-502-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 7450 SCENIC VIEW DR
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City | MACUNGIE
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State | PA
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Zip | 18062-2149
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | OC006476L
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License Number State | PA
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