Provider Demographics
NPI:1700940012
Name:YUDIN, JEAN A (CRNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:YUDIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:GLASSER
Other - Last Name:YUDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3615 CHESTNUT ST
Mailing Address - Street 2:RALSTON-PENN CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2612
Mailing Address - Country:US
Mailing Address - Phone:215-662-2746
Mailing Address - Fax:
Practice Address - Street 1:3615 CHESTNUT ST
Practice Address - Street 2:RALSTON-PENN CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2612
Practice Address - Country:US
Practice Address - Phone:215-662-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001574H363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006662EJ5Medicare ID - Type Unspecified
S49793Medicare UPIN