Provider Demographics
NPI:1972067726
Name:JBR WOUND MANAGEMENT LLC
Entity Type:Organization
Organization Name:JBR WOUND MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:215-460-7705
Mailing Address - Street 1:1637 E BUTLER PIKE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2733
Mailing Address - Country:US
Mailing Address - Phone:215-460-7705
Mailing Address - Fax:215-540-3979
Practice Address - Street 1:177 DUFFIELD ST
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2106
Practice Address - Country:US
Practice Address - Phone:215-460-7705
Practice Address - Fax:215-659-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019495890005Medicaid
PAMR1742837OtherDEA NUMBER