Provider Demographics
NPI:1376825588
Name:SIPE, JENNIFER L (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SIPE
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 1:821 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8371
Mailing Address - Country:US
Mailing Address - Phone:215-379-4001
Mailing Address - Fax:
Practice Address - Street 1:821 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 205
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8371
Practice Address - Country:US
Practice Address - Phone:215-379-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006926C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health