=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346893401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA DANIELLE STRIEBIG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2019
-----------------------------------------------------
Last Update Date | 06/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 LONDONDERRY RD STE 202
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17109-5317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-724-6780
-----------------------------------------------------
Fax | 717-724-6781
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1703 INNOVATION DR STE 2001
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17408-8815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-801-0765
-----------------------------------------------------
Fax | 717-801-0645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | MA060811
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------