Provider Demographics
NPI:1396179974
Name:PERSSON, JENNY ROSE (ACNP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ROSE
Last Name:PERSSON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WEST CHELTEN AVENUE
Mailing Address - Street 2:205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:307-760-1376
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVENUE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430758363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care