Provider Demographics
NPI:1134525256
Name:STRADER, JENAE ANN (CRNP)
Entity type:Individual
Prefix:
First Name:JENAE
Middle Name:ANN
Last Name:STRADER
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 1:85 PRICE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1832
Mailing Address - Country:US
Mailing Address - Phone:214-764-0985
Mailing Address - Fax:
Practice Address - Street 1:732 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2004
Practice Address - Country:US
Practice Address - Phone:215-922-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013461363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health