MEDICARE: MRS. JENA E MORCELLE RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	P83249	NY

General Provider Information

NPI Number	:	1326312513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENA E MORCELLE RPA-C

Provider Business Mailing Address
First Line	:	140 HODGE AVE
Second Line	:	2ND FLOOR - PEDIATRIC SURGERY
City	:	BUFFALO
State	:	NY
Zip	:	14222-2034
Country	:	US
Telephone Number	:	716-878-7000
Fax Number	:	716-878-7809

Provider Business Practice Location Address
First Line	:	140 HODGE AVE
Second Line	:	2ND FLOOR - PEDIATRIC SURGERY
City	:	BUFFALO
State	:	NY
Zip	:	14222-2034
Country	:	US
Telephone Number	:	716-878-7000
Fax Number	:	716-878-7809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	01/05/2016

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