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General NPI Number Information
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NPI Number | 1992856413
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Entity Type | Individual
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Provider Name | JENNIFER ANNE ERICKSON N.P.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 7602 CENTRAL AVE SUITE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2443
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Country | US
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Telephone | 215-969-2900
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Fax | 215-969-1856
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Provider Business Mailing Address
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Address Line | 2450 W HUNTING PARK AVE 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1302
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Country | US
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Telephone | 215-926-9022
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Fax | 215-226-8286
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP007259
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License Number State | PA
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