Provider Demographics
NPI:1477195014
Name:ABDUL-RAHMAN, JENNIFER (BSN RN IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ABDUL-RAHMAN
Suffix:
Gender:F
Credentials:BSN RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COPLAY
Mailing Address - State:PA
Mailing Address - Zip Code:18037-2432
Mailing Address - Country:US
Mailing Address - Phone:484-597-1095
Mailing Address - Fax:
Practice Address - Street 1:2475 SPRING ST
Practice Address - Street 2:
Practice Address - City:COPLAY
Practice Address - State:PA
Practice Address - Zip Code:18037-2432
Practice Address - Country:US
Practice Address - Phone:484-597-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN624351163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant