Healthcare Provider Details

I. General information

NPI: 1457339459
Provider Name (Legal Business Name): JENNIFER L MACDONALD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL DR STE 312
LEWISBURG PA
17837-8909
US

IV. Provider business mailing address

1 HOSPITAL DR STE 306
LEWISBURG PA
17837-9350
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-8700
  • Fax: 570-523-8705
Mailing address:
  • Phone: 570-522-4110
  • Fax: 570-768-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA 051250
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: