Healthcare Provider Details

I. General information

NPI: 1467400945
Provider Name (Legal Business Name): JAUHNA K DEUTSCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 GATEWAY BLVD SUITE 2120
NEWBURGH IN
47630-8925
US

IV. Provider business mailing address

4015 GATEWAY BLVD SUITE 2120
NEWBURGH IN
47630-8925
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-0907
  • Fax: 812-464-0555
Mailing address:
  • Phone: 812-842-0907
  • Fax: 812-464-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number99014177A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: