Provider Demographics
NPI:1033307723
Name:SHAPIRO, JACQUELINE S (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:FISHBEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 LANCASTER AVE
Mailing Address - Street 2:LANKENAU HOSPITAL DEPART OF OB//GYN
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:484-476-4650
Mailing Address - Fax:610-645-3577
Practice Address - Street 1:100 LANCASTER AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:484-476-4650
Practice Address - Fax:610-645-3577
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007193363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology