Provider Demographics
NPI:1255509857
Name:JASIONOWSKI, PAULA CAROL (APN,C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:CAROL
Last Name:JASIONOWSKI
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:BLDG. 800 SUITE 122
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-770-9300
Mailing Address - Fax:856-770-8238
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:BLDG. 800 SUITE 122
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-770-9300
Practice Address - Fax:856-770-8238
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04700700363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS62796Medicare UPIN