Doctor Name: | MRS. JENNA LAUREN SYNNAMON |
NPI Number: | 1366712960 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | MA 055270 |
Business Practice Address: | 701 Ostrum St Suite 502 Fountain Hill, PA - 180151155 |
Business Phone Number: | 4845267555 |
Business Fax Number: | 4845267556 |
Mailing Address: | 701 Ostrum St, Suite 502 FOUNTAIN HILL |
State: | PA |
Postal Code: | 180151155 |
Phone Number: | 4845267555 |
Fax Number: | 4845267556 |
NPI Enumeration Date: | 01/12/2012 |
NPI Last Update Date: | 12/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA 055270 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |