Provider Demographics
NPI:1013209360
Name:MATHIESON, JESSICA ELIZABETH (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:MATHIESON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:941 SOUTH AVE
Mailing Address - Street 2:APT A29
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3431
Mailing Address - Country:US
Mailing Address - Phone:610-764-7178
Mailing Address - Fax:
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:POB #1 - SUITE 305
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:610-447-6021
Practice Address - Fax:610-447-2179
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2014-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054816363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical