Provider Demographics
NPI:1063789030
Name:KELLY, JENNIFER ZUCAL (RN, CPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ZUCAL
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1417
Mailing Address - Country:US
Mailing Address - Phone:814-335-4537
Mailing Address - Fax:
Practice Address - Street 1:215 E 5TH ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1417
Practice Address - Country:US
Practice Address - Phone:814-335-4537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2014-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN575349163W00000X
374J00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374J00000XNursing Service Related ProvidersDoula
No176B00000XOther Service ProvidersMidwife