Provider Demographics
NPI:1073803102
Name:JEWETT, LORRAINE A (PA-C)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:A
Last Name:JEWETT
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 1:2301 S. BROAD STREET
Mailing Address - Street 2:MEDICAL STAFF OFFICE, DEPT OF SURGERY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148
Mailing Address - Country:US
Mailing Address - Phone:215-952-9000
Mailing Address - Fax:215-952-1246
Practice Address - Street 1:2301 S BROAD ST
Practice Address - Street 2:MEDICAL STAFF OFFICE, DEPT OF SURGERY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-952-9000
Practice Address - Fax:215-952-1246
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001958L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical