| NPI | 1538728357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Payer Supervisor 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2021-05-19 |