Provider Demographics
NPI:1083952360
Name:VAZQUEZ, JENEAL M (CNM)
Entity Type:Individual
Prefix:
First Name:JENEAL
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JENEAL
Other - Middle Name:M
Other - Last Name:GUISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-763-9880
Practice Address - Fax:717-737-2765
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010298367A00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife