Provider Demographics
NPI:1144972803
Name:STENGEL, JESSICA ADELE CLAIRE (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ADELE CLAIRE
Last Name:STENGEL
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5801 S TRANSIT RD # 280-6589
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5811
Mailing Address - Country:US
Mailing Address - Phone:716-864-6002
Mailing Address - Fax:
Practice Address - Street 1:5801 S TRANSIT RD # 280-6589
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5811
Practice Address - Country:US
Practice Address - Phone:716-864-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant