Provider Demographics
NPI:1144474933
Name:LONAC, JENNIFER LILA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LILA
Last Name:LONAC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-233-7489
Practice Address - Street 1:6007 244TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5427
Practice Address - Country:US
Practice Address - Phone:425-640-4830
Practice Address - Fax:425-640-4885
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60061940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant