Provider Demographics
NPI:1962549337
Name:PETRUNIS, JENNIFER (BSN, RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PETRUNIS
Suffix:
Gender:
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N DELAWARE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4228
Mailing Address - Country:US
Mailing Address - Phone:215-387-3223
Mailing Address - Fax:215-387-3203
Practice Address - Street 1:520 N DELAWARE AVE STE 303
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4228
Practice Address - Country:US
Practice Address - Phone:215-387-3223
Practice Address - Fax:215-387-3203
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN702983163WP0808X
WARN60081396163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health