Provider Demographics
NPI:1902159882
Name:JERNEGAN, ELIZABETH CATHERINE (BA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:JERNEGAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:BROSIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:224 NAZARETH PIKE
Mailing Address - Street 2:SUITE 22A
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9080
Mailing Address - Country:US
Mailing Address - Phone:610-365-8373
Mailing Address - Fax:610-365-2522
Practice Address - Street 1:224 NAZARETH PIKE
Practice Address - Street 2:SUITE 22A
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9080
Practice Address - Country:US
Practice Address - Phone:610-365-8373
Practice Address - Fax:610-365-2522
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist