Doctor Name: | JACQUELYN MENARDE |
NPI Number: | 1568864817 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | MA057211 |
Business Practice Address: | 649 N Lewis Rd Suite 225 Royersford, PA - 194681234 |
Business Phone Number: | 6104953620 |
Business Fax Number: | |
Mailing Address: | 649 N Lewis Rd, Suite 225 ROYERSFORD |
State: | PA |
Postal Code: | 194681234 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/18/2014 |
NPI Last Update Date: | 09/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA057211 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |