Provider Demographics
NPI:1144296948
Name:MOWDAY, JACQUELYN ELIZABETH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:ELIZABETH
Last Name:MOWDAY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:JACQUELYN
Other - Middle Name:ELIZABETH
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1991 SPROUL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3512
Mailing Address - Country:US
Mailing Address - Phone:610-325-1350
Mailing Address - Fax:610-325-1357
Practice Address - Street 1:1991 SPROUL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3512
Practice Address - Country:US
Practice Address - Phone:610-325-1350
Practice Address - Fax:610-325-1357
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005873G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW232359401OtherMAIN LINE HEALTHCARE
P15573Medicare UPIN
PW232359401OtherMAIN LINE HEALTHCARE