Provider Demographics
NPI:1588915813
Name:MCGOVERN, JENNIFER JEAN (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:158 JOSEPH LANE
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346
Mailing Address - Country:US
Mailing Address - Phone:570-801-1480
Mailing Address - Fax:
Practice Address - Street 1:158 JOSEPH LANE
Practice Address - Street 2:
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346
Practice Address - Country:US
Practice Address - Phone:570-801-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401515363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health