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General NPI Number Information
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NPI Number | 1376563924
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Entity Type | Individual
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Provider Name | JENISE VICTORIA BACON MENSHEW PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 1240 HUFFMAN MILL RD
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City | BURLINGTON
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State | NC
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Zip | 27215-8700
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Country | US
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Telephone | 336-538-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 KILDARE WOODS DR
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City | GREENSBORO
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State | NC
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Zip | 27407-6370
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Country | US
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Telephone | 404-556-1039
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0961
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License Number State | TN
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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 | 4331
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 104189
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License Number State | NC
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