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NPI Code Detail

MEDICARE: STEPHEN LUKE JAUSSEN

MEDICARE:   STEPHEN LUKE JAUSSEN
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
1363A00000XPhysician AssistantOA007023PA

General Provider Information

NPI Number : 1710712211
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN LUKE JAUSSEN
Provider Business Mailing Address
First Line : 321 ARCH ST STE 101
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3214
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 321 ARCH ST STE 101
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3214
Country : US
Telephone Number : 833-447-5633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2024
Last Update Date : 10/24/2024

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Directions to “ STEPHEN LUKE JAUSSEN ” Practice Location

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