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1790726685 NPI number — BETH A JEWELL PA-C

NPI Number: 1790726685
Health Care Provider/Practitioner: BETH A JEWELL PA-C

Information about “1790726685” NPI (BETH A JEWELL PA-C) exists in 1790726685 in HTML format HTML  |  1790726685 in plain Text format TXT  |  1790726685 in PDF (Portable Document Format) PDF  |  1790726685 in an XML format XML  formats.

NPI Number : 1790726685 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790726685",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JEWELL",
    "FirstName": "BETH",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ENGEL",
    "OtherFirstName": "BETH",
    "OtherMiddleName": "A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2403 FOLSOM ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAU CLAIRE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54703-2435",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-552-9784",
    "MailingAddressFaxNumber": "715-835-6370",
    "FirstLinePracticeLocationAddress": "2661 COUNTY HIGHWAY I",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHIPPEWA FALLS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54729-5407",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-861-0990",
    "PracticeLocationAddressFaxNumber": "715-861-0274",
    "EnumerationDate": "06/09/2006",
    "LastUpdateDate": "01/02/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "919-023",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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