MEDICARE: ELIANNE JOSEL CRNP

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	SP018232	PA

General Provider Information

NPI Number	:	1699281238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIANNE JOSEL CRNP

Provider Business Mailing Address
First Line	:	701 MONTGOMERY AVE STE 18
Second Line	:
City	:	PENN VALLEY
State	:	PA
Zip	:	19072-2036
Country	:	US
Telephone Number	:	610-642-9200
Fax Number	:	610-649-4723

Provider Business Practice Location Address
First Line	:	701 MONTGOMERY AVE STE 18
Second Line	:
City	:	PENN VALLEY
State	:	PA
Zip	:	19072-2036
Country	:	US
Telephone Number	:	610-642-9200
Fax Number	:	610-649-4723

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

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	03/17/2018

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