Provider Demographics
NPI:1063460012
Name:PODGURSKI, JENNIFER SHUGARS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SHUGARS
Last Name:PODGURSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 PROCURE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526
Mailing Address - Country:US
Mailing Address - Phone:919-577-9952
Mailing Address - Fax:919-577-9946
Practice Address - Street 1:1006 PROCURE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:919-577-9952
Practice Address - Fax:919-577-9946
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P05853Medicare UPIN
NC2759393Medicare ID - Type Unspecified