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General NPI Number Information
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NPI Number | 1669779658
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Entity Type | Individual
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Provider Name | ALLISON R JURGAITIS NP
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Gender | Female
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 122 SILVER LAKE RD MIDDLETOWN HIGH SCHOOL
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1225
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Country | US
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Telephone | 302-378-5775
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Fax | 302-378-5760
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Provider Business Mailing Address
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Address Line | 200 HYGEIA DR SUITE 2300
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City | NEWARK
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State | DE
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Zip | 19713-2049
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Country | US
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Telephone | 856-881-7495
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | SP007315
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LG-0000700
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License Number State | DE
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