Healthcare Provider Details

I. General information

NPI: 1558397075
Provider Name (Legal Business Name): JANE M. JENC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ELM ST N CENTRACARE HEALTH SYSTEM - SAUK CENTRE
SAUK CENTRE MN
56378-1010
US

IV. Provider business mailing address

425 ELM ST N CENTRACARE HEALTH SYSTEM - SAUK CENTRE
SAUK CENTRE MN
56378-1010
US

V. Phone/Fax

Practice location:
  • Phone: 320-352-6591
  • Fax: 320-352-5164
Mailing address:
  • Phone: 320-352-6591
  • Fax: 320-352-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9244
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: