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General NPI Number Information
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NPI Number | 1841737202
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Entity Type | Individual
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Provider Name | JACOB TRUDEAU PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 950 E BOGARD RD STE 103
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City | WASILLA
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State | AK
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Zip | 99654-7184
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Country | US
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Telephone | 907-352-2883
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Fax | 907-352-2805
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Provider Business Mailing Address
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Address Line | 1207 JOSEPH CT
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City | GIBSONIA
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State | PA
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Zip | 15044-8057
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Country | US
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Telephone | 412-779-0519
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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 |
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License Number State |
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