Healthcare Provider Details

I. General information

NPI: 1821371014
Provider Name (Legal Business Name): ERICA JANE PELINSKI P.A. - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA JANE PASZKOWSKI

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E COMMERCIAL ST
LEBANON MO
65536-3257
US

IV. Provider business mailing address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-3990
  • Fax: 573-302-2753
Mailing address:
  • Phone: 573-302-3990
  • Fax: 573-302-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2021042544
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: