Provider Demographics
NPI:1316051246
Name:BRICK, JANE H (MSN,CRNP)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:H
Last Name:BRICK
Suffix:
Gender:F
Credentials:MSN,CRNP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:HINKLE
Other - Last Name:BRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP
Mailing Address - Street 1:319 REILLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2205
Mailing Address - Country:US
Mailing Address - Phone:856-428-5389
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:PHILADELPHIA VETERANS AFFAIR MEDICAL CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000796H363L00000X
NJ26NN02245800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology