Provider Demographics
NPI:1063484657
Name:MCCAMBRIDGE, JENNIFER E (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:MCCAMBRIDGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2926
Mailing Address - Country:US
Mailing Address - Phone:641-422-6730
Mailing Address - Fax:641-422-6659
Practice Address - Street 1:250 S CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2926
Practice Address - Country:US
Practice Address - Phone:641-422-6730
Practice Address - Fax:641-422-6659
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP14654Medicare UPIN
IAI8423Medicare ID - Type Unspecified
IA0355010044Medicare NSC