Provider Demographics
NPI:1669185443
Name:JEANTY, MURIELLE MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:MURIELLE
Middle Name:MARIE
Last Name:JEANTY
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 1:122 S TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2858
Mailing Address - Country:US
Mailing Address - Phone:215-657-2012
Mailing Address - Fax:215-657-2018
Practice Address - Street 1:735 FITZWATERTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1338
Practice Address - Country:US
Practice Address - Phone:215-657-2012
Practice Address - Fax:215-657-2018
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026648363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology