Healthcare Provider Details

I. General information

NPI: 1346678141
Provider Name (Legal Business Name): JILL M SENG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W 2ND ST STE 2A
JASPER IN
47546-3240
US

IV. Provider business mailing address

800 W 9TH ST
JASPER IN
47546-2514
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-5950
  • Fax: 812-996-5951
Mailing address:
  • Phone: 812-996-0299
  • Fax: 812-996-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0004544
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001594A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: