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General NPI Number Information
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NPI Number | 1609590470
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Entity Type | Organization
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Legal Business Name | PEAR PROGRAM INC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 1010 MOUNT PLEASANT AVE
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City | WAYNE
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State | PA
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Zip | 19087-2715
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Country | US
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Telephone | 484-969-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 MOUNT PLEASANT AVE
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City | WAYNE
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State | PA
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Zip | 19087-2715
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Country | US
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Telephone | 484-969-0045
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SHAWN JACKSON
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Credential | NP
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Telephone | 484-969-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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