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General NPI Number Information
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NPI Number | 1922475912
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Entity Type | Individual
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Provider Name | JESSICA W CONNELL CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 414 PAOLI PIKE REHABILITATION ASSOCIATES OF THE MAIN LINE
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City | MALVERN
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State | PA
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Zip | 19355-3311
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Country | US
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Telephone | 484-596-3969
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Fax |
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Provider Business Mailing Address
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Address Line | 414 PAOLI PIKE REHABILITATION ASSOCIATES OF THE MAIN LINE
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City | MALVERN
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State | PA
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Zip | 19355-3311
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Country | US
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Telephone | 484-596-3969
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN587962
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP014900
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License Number State | PA
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