Basic Information
Provider Information
NPI: 1841950078
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOLEY
FirstName: JESSICA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2906 MARLEY LN
Address2:  
City: PHOENIXVILLE
State: PA
PostalCode: 194603079
CountryCode: US
TelephoneNumber: 7322390579
FaxNumber:  
Practice Location
Address1: 111 S 11TH ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191074824
CountryCode: US
TelephoneNumber: 2159556000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/29/2021
LastUpdateDate: 03/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XSP024478PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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