Provider Demographics
NPI:1033272851
Name:PESCI, JAN MARIE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:MARIE
Last Name:PESCI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:MARIE
Other - Last Name:FABISZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:565 COAL VALLEY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3703
Mailing Address - Country:US
Mailing Address - Phone:412-578-7457
Mailing Address - Fax:412-578-3014
Practice Address - Street 1:565 COAL VALLEY RD FL 2
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3703
Practice Address - Country:US
Practice Address - Phone:412-578-7457
Practice Address - Fax:412-578-3014
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051376363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13687800OtherCAQH
PAQ30475Medicare UPIN