Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP021416 | PA |
NPI | 1033741988 |
---|---|
Provider Name | Ms. Sheila O. Jourdain |
First Address | Temple, PA 19560-0008 |
Second Address | Lancaster, PA 17602-2287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2020 |
Last Update Date | 09/02/2020 |