Provider Demographics
NPI:1346290038
Name:GITTENS, JOELLEN (CRNP)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:GITTENS
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 1:743 JEFFERSON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1635
Mailing Address - Country:US
Mailing Address - Phone:570-341-9818
Mailing Address - Fax:570-341-9950
Practice Address - Street 1:743 JEFFERSON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1635
Practice Address - Country:US
Practice Address - Phone:570-341-9818
Practice Address - Fax:570-341-9950
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN232769L163W00000X
PAUP003033C163WW0101X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN232769LOtherRN LICENSE
PAUP003033COtherNURSE PRACTIONER LICENSE
PA1028855130002Medicaid
PA1028855130003Medicaid
PA011111YGDBMedicare PIN