Provider Demographics
NPI:1235330838
Name:PELLEGRINO, JEAN MARIE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8118 OLD YORK RD STE D
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1423
Mailing Address - Country:US
Mailing Address - Phone:215-635-3151
Mailing Address - Fax:215-635-3165
Practice Address - Street 1:8118 OLD YORK RD STE D
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1423
Practice Address - Country:US
Practice Address - Phone:215-635-3151
Practice Address - Fax:215-635-3165
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily