Individual
MRS. JACQUELYN ELIZABETH MOWDAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1991 SPROUL RD, SUITE 200, BROOMALL, PA 19008-3512
(610) 325-1350
(610) 325-1357
Mailing address
1991 SPROUL RD, SUITE 200, BROOMALL, PA 19008-3512
(610) 325-1350
(610) 325-1357
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
SP005873G
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232359401
MAIN LINE HEALTHCARE
PW
Enumeration date
02/23/2006
Last updated
08/24/2017
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