Individual
DR. CARISSA M JEANNETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
245 N 15TH ST RM 2108, PHILADELPHIA, PA 19102-1101
(215) 762-4172
Mailing address
245 N 15TH ST RM 2108, PHILADELPHIA, PA 19102-1101
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OT019421
PA
Other
Enumeration date
06/18/2019
Last updated
06/18/2019
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