Provider Demographics
NPI:1922650936
Name:GOLDEN, JENNIFER QUIMBY (CPM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:QUIMBY
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E FARMERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8510
Mailing Address - Country:US
Mailing Address - Phone:717-847-7577
Mailing Address - Fax:717-842-7912
Practice Address - Street 1:4 E FARMERSVILLE RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8510
Practice Address - Country:US
Practice Address - Phone:717-847-7577
Practice Address - Fax:717-842-7912
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133490146N00000X
PA19060012175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
19060012OtherNARM