Healthcare Provider Details

I. General information

NPI: 1720976301
Provider Name (Legal Business Name): JASMINE CHAN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 FRANCISCAN WAY
LORETTO PA
15940-9703
US

IV. Provider business mailing address

310 CHESTNUT HILL ST
GAITHERSBURG MD
20878-2178
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1235192
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: