Provider Demographics
NPI:1083680524
Name:COREY, JANE M (CRNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:COREY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:330 LANKENAU MOB WEST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-645-6555
Mailing Address - Fax:610-649-4744
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:330 LANKENAU MOB WEST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-6555
Practice Address - Fax:610-649-4744
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004577H363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S60733Medicare UPIN
PA013686HK1Medicare ID - Type Unspecified