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General NPI Number Information
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NPI Number | 1336484344
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Entity Type | Individual
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Provider Name | JOLENE ELIZABETH BOHENSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/02/2012
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 361 N MAIN ST
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City | GLASSBORO
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State | NJ
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Zip | 08028-1920
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Country | US
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Telephone | 856-881-8618
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Fax |
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Provider Business Mailing Address
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Address Line | 361 N MAIN ST
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City | GLASSBORO
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State | NJ
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Zip | 08028-1920
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Country | US
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Telephone | 856-881-8618
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00296500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA056066
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License Number State | PA
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