Provider Demographics
NPI:1285840793
Name:SUNDERLAND, JENNIFER LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:SUNDERLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 KISH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-8943
Mailing Address - Country:US
Mailing Address - Phone:717-667-7720
Mailing Address - Fax:717-667-7249
Practice Address - Street 1:96 KISH RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084-8943
Practice Address - Country:US
Practice Address - Phone:717-667-7720
Practice Address - Fax:717-667-7249
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant