Healthcare Provider Details

I. General information

NPI: 1992497028
Provider Name (Legal Business Name): JEMA REASONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 UNIVERSITY SQ
ERIE PA
16541-0002
US

IV. Provider business mailing address

230 W 8TH ST APT 3E
ERIE PA
16501-1633
US

V. Phone/Fax

Practice location:
  • Phone: 814-871-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: