MEDICARE: MARIANNE DEBRUIJN JOLIN CNM

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	367A00000X	Advanced Practice Midwife	MW008433L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	1603980	OTHER	PA	GATEWAY MEDICARE ASSURED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30108963	OTHER	PA	AMERIHEALTH MERCY-WMG
2	417697	OTHER	PA	UPMC
3	30111723	OTHER	PA	AMERIHEALTH MERCY-WMG ACWH
4	269244	OTHER	PA	HIGHMARK BLUE SHIELD
5	5155716	OTHER	PA	AETNA PPO PROVIDER NUMBER
7	3432450	OTHER	PA	AETNA HMO PROVIDER NUMBER
8	50026638	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1518939479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE DEBRUIJN JOLIN CNM

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-337-4487
Fax Number	:	717-461-7149

Provider Business Practice Location Address
First Line	:	450 S WASHINGTON ST STE B
Second Line	:
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-2500
Country	:	US
Telephone Number	:	717-337-4487
Fax Number	:	717-461-7149

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	10/19/2021

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