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General NPI Number Information
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NPI Number | 1609648849
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Entity Type | Organization
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Legal Business Name | OPTIMUM HEALTH SOLUTIONS
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 5925 HAVERFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19151-4407
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Country | US
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Telephone | 610-304-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 HAVERFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19151-4407
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Country | US
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Telephone | 610-304-3266
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | INAISHA MARIE JACKSON
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Credential | CRNP
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Telephone | 610-304-3266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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