Doctor Name: | JORDANA FAITH POPOVICH |
NPI Number: | 1700216983 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 024740 |
Business Practice Address: | 701 Montgomery Ave Suite 18 Penn Valley, PA - 190722036 |
Business Phone Number: | 6106429200 |
Business Fax Number: | 6106494723 |
Mailing Address: | 100 Overhill Rd, BALA CYNWYD |
State: | PA |
Postal Code: | 190042229 |
Phone Number: | 6106492652 |
Fax Number: | |
NPI Enumeration Date: | 11/25/2013 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 024740 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |