MEDICARE: JACQUELINE CHURCHMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP022224	PA

General Provider Information

NPI Number	:	1184233496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE CHURCHMAN

Provider Business Mailing Address
First Line	:	250 SUNSET HOLLOW RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3840
Country	:	US
Telephone Number	:	610-283-8446
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 SUNSET HOLLOW RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-3840
Country	:	US
Telephone Number	:	610-283-8446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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Directions to “ JACQUELINE CHURCHMAN ” Practice Location

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