1396262564 NPI number — JENNA ROSE MCFARLAN MA

Table of content: JENNA ROSE MCFARLAN MA (NPI 1396262564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396262564 NPI number — JENNA ROSE MCFARLAN MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCFARLAN
Provider First Name:
JENNA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLYNN
Provider Other First Name:
JENNA
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396262564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1358 W WYOMISSING CT APT M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LAWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19609-2353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-320-5846
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
283 BUTLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-8939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-273-8871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2017

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: 390200000X , 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)