Healthcare Provider Details

I. General information

NPI: 1346296274
Provider Name (Legal Business Name): JOCELYN HENNING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOCELYN REMILLARD

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL PL DEPT OF MEDICINE
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

PO BOX 62026
BALTIMORE MD
21264-2026
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003191
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003191
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: