Basic Information
| Provider Information | |||||||||
| NPI: | 1295361160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTER | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | YVETTE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | COLLINGSWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098024370 | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 E ERIE AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191341011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154275000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2020 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP021687 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.