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General NPI Number Information
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NPI Number | 1922403039
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Entity Type | Individual
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Provider Name | JAMIE DENNIS
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Gender | Female
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 1011 N HANCOCK ST APT 206
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City | PHILADELPHIA
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State | PA
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Zip | 19123-2348
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Country | US
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Telephone | 513-315-2493
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 ATRIUM WAY STE 6
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-3917
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Country | US
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Telephone | 513-315-2493
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00410300
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License Number State | NJ
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