Provider Demographics
NPI:1871635854
Name:BERNOSKY, JEANNE L (CRNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:BERNOSKY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:S
Other - Last Name:BERNOSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-204-2679
Mailing Address - Fax:215-204-1784
Practice Address - Street 1:1700 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121
Practice Address - Country:US
Practice Address - Phone:215-204-7500
Practice Address - Fax:215-204-4660
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004390C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine