Healthcare Provider Details

I. General information

NPI: 1063749372
Provider Name (Legal Business Name): JENNIFER A HOFFMASTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER A WAGNER PA-C

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 JPM ROAD
LEWISBURG PA
17837-9313
US

IV. Provider business mailing address

137 JPM ROAD
LEWISBURG PA
17837-9313
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-3937
  • Fax: 570-524-5279
Mailing address:
  • Phone: 570-523-3937
  • Fax: 570-524-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054203
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: