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General NPI Number Information
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NPI Number | 1821371014
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Entity Type | Individual
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Provider Name | ERICA JANE PELINSKI P.A. - C
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 128 E COMMERCIAL ST
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City | LEBANON
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State | MO
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Zip | 65536-3257
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Country | US
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Telephone | 573-302-3990
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Fax | 573-302-2753
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Provider Business Mailing Address
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Address Line | 54 HOSPITAL DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3050
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Country | US
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Telephone | 573-302-3990
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Fax | 573-302-2753
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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 | 2021042544
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License Number State | MO
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