Provider Demographics
NPI:1104693365
Name:LILIENTHAL, JESSICA L (MSN, FNP-C, CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LILIENTHAL
Suffix:
Gender:F
Credentials:MSN, FNP-C, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 RIDGEWOOD RD STE 180
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1190
Mailing Address - Country:US
Mailing Address - Phone:484-268-6784
Mailing Address - Fax:
Practice Address - Street 1:2201 RIDGEWOOD RD STE 180
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19610-1190
Practice Address - Country:US
Practice Address - Phone:610-373-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily