Provider Demographics
NPI:1457983447
Name:JAWORSKI, ELENA MARIE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 S BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4517
Mailing Address - Country:US
Mailing Address - Phone:267-997-8958
Mailing Address - Fax:
Practice Address - Street 1:2617 S BANCROFT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4517
Practice Address - Country:US
Practice Address - Phone:267-997-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-157594163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant