MEDICARE: MRS. JENNIFER GANIME

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	363LP0200X	Pediatric Nurse Practitioner	SP029620	PA

General Provider Information

NPI Number	:	1316700669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER GANIME

Provider Business Mailing Address
First Line	:	3180 FASHION CENTER BLVD
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19702-3246
Country	:	US
Telephone Number	:	484-744-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	527 BALTIMORE PIKE
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-3839
Country	:	US
Telephone Number	:	484-470-6777
Fax Number	:

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	07/29/2024

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