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NPI Code Detail

MEDICARE: JENNIFER ANDERSON

MEDICARE: JENNIFER ANDERSON
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
1163W00000XRegistered NurseRN532587PA

General Provider Information

NPI Number : 1710494273
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANDERSON
Provider Business Mailing Address
First Line : 142 LEAGUE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-4225
Country : US
Telephone Number : 215-207-5266
Fax Number :
Provider Business Practice Location Address
First Line : 5500 TABOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19120-2124
Country : US
Telephone Number : 215-388-1806
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2018
Last Update Date : 01/05/2018

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Directions to “ JENNIFER ANDERSON ” Practice Location

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