MEDICARE: MISS JACQUELYN LEE ENGLISH PA-C

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	363AS0400X	Surgical Physician Assistant	MA051722	PA

General Provider Information

NPI Number	:	1851620660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JACQUELYN LEE ENGLISH PA-C

Provider Business Mailing Address
First Line	:	ERIE AVENUE AT FRONT STREET
Second Line	:	ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134
Country	:	US
Telephone Number	:	215-427-5292
Fax Number	:	215-427-4616

Provider Business Practice Location Address
First Line	:	3601 A STREET
Second Line	:	SUITE 2204 ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134
Country	:	US
Telephone Number	:	215-427-5292
Fax Number	:	215-427-4616

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

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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