Provider Demographics
NPI:1871609651
Name:STASCHAK, JESSICA (CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STASCHAK
Suffix:
Gender:F
Credentials:CRNP
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Other - Credentials:
Mailing Address - Street 1:34TH ST & CIVIC CENTER BLVD ORTHOPAEDIC SURGERY DIV
Mailing Address - Street 2:THE CHILDRENS HOSPITAL OF PHILADELPHIA
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4399
Mailing Address - Country:US
Mailing Address - Phone:215-590-1527
Mailing Address - Fax:215-590-1501
Practice Address - Street 1:34TH ST & CIVIC CENTER BLVD ORTHOPAEDIC SURGERY DIV
Practice Address - Street 2:THE CHILDRENS HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-1527
Practice Address - Fax:215-590-1501
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008191363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics