Basic Information
| Provider Information | |||||||||
| NPI: | 1902896632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIBERATI | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | B.S., RN, MSN, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 GREENBRIAR LN | ||||||||
| Address2: | |||||||||
| City: | HAVERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190832847 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 CIVIC CENTER BLVD | ||||||||
| Address2: | ROBERT WOOD BUILDING 1ST FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191045127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155903440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN543487 | PA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 26NR11548300 | NJ | N | Nursing Service Providers | Registered Nurse | 363LP0200X | SP008107 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 163WL0100X | L-56479 | PA | N | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.