Provider Demographics
NPI:1326075227
Name:DIMEDIO, JENNIFER (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DIMEDIO
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 1:400 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5412
Mailing Address - Country:US
Mailing Address - Phone:610-696-6511
Mailing Address - Fax:610-429-1840
Practice Address - Street 1:400 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5412
Practice Address - Country:US
Practice Address - Phone:610-696-6511
Practice Address - Fax:610-429-1840
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005711B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner