Provider Demographics
NPI:1730663550
Name:SODER, JENNA LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:SODER
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 1:5307 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-4105
Mailing Address - Country:US
Mailing Address - Phone:724-462-6876
Mailing Address - Fax:
Practice Address - Street 1:600 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1814
Practice Address - Country:US
Practice Address - Phone:855-968-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726046163W00000X
OH024002363LF0000X
NY343886363LF0000X
PASP019380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse