| Doctor Name: | JACQUELINE KIVITZ |
| NPI Number: | 1356734735 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | SP014798 |
| Business Practice Address: | 1100 E Hector St Suite 105 Conshohocken, PA - 194282374 |
| Business Phone Number: | 6108282608 |
| Business Fax Number: | 6108280102 |
| Mailing Address: | 1100 E Hector St, Suite 105 CONSHOHOCKEN |
| State: | PA |
| Postal Code: | 194282374 |
| Phone Number: | 6108282608 |
| Fax Number: | 6108280102 |
| NPI Enumeration Date: | 03/10/2015 |
| NPI Last Update Date: | 09/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | SP014798 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |