Provider Demographics
NPI:1487404398
Name:ADVANCING WELLNESS IN PSYCHIATRY, NURSE PRACTITIONER SERVICES, LLC
Entity type:Organization
Organization Name:ADVANCING WELLNESS IN PSYCHIATRY, NURSE PRACTITIONER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PMHNP-BC
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:570-212-9590
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346-0428
Mailing Address - Country:US
Mailing Address - Phone:705-212-9590
Mailing Address - Fax:
Practice Address - Street 1:138 NADINE BLVD
Practice Address - Street 2:
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346-7834
Practice Address - Country:US
Practice Address - Phone:570-212-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty