Provider Demographics
NPI:1639414220
Name:JACOBI, WENDY JUNE (CRNP)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:JUNE
Last Name:JACOBI
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 1:28 VERSAILLES BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-5133
Mailing Address - Country:US
Mailing Address - Phone:570-977-6636
Mailing Address - Fax:
Practice Address - Street 1:800 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2604
Practice Address - Country:US
Practice Address - Phone:856-663-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012560363LF0000X
NJ26NJ00641900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily