Individual
JESSICA WEATHERWAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 316-5151
Mailing address
309 LOCUST AVE, HADDON TOWNSHIP, NJ 08108-2420
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP023562
PA
Other
Enumeration date
04/03/2021
Last updated
04/03/2021
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