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General NPI Number Information
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NPI Number | 1073803102
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Entity Type | Individual
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Provider Name | LORRAINE A JEWETT PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 2301 S BROAD ST MEDICAL STAFF OFFICE, DEPT OF SURGERY
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3542
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Country | US
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Telephone | 215-952-9000
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Fax | 215-952-1246
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Provider Business Mailing Address
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Address Line | 2301 S. BROAD STREET MEDICAL STAFF OFFICE, DEPT OF SURGERY
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City | PHILADELPHIA
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State | PA
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Zip | 19148
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Country | US
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Telephone | 215-952-9000
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Fax | 215-952-1246
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MA001958L
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License Number State | PA
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