1144296948 NPI number — MRS. JACQUELYN ELIZABETH MOWDAY NURSE PRACTITIONER

Table of content: MRS. JACQUELYN ELIZABETH MOWDAY NURSE PRACTITIONER (NPI 1144296948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144296948 NPI number — MRS. JACQUELYN ELIZABETH MOWDAY NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOWDAY
Provider First Name:
JACQUELYN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KERR
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144296948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1991 SPROUL RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-325-1350
Provider Business Mailing Address Fax Number:
610-325-1357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 SPROUL RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-325-1350
Provider Business Practice Location Address Fax Number:
610-325-1357
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  SP005873G , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 232359401 . This is a "MAIN LINE HEALTHCARE" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".




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