Provider Demographics
NPI:1285844993
Name:WILL, JEANNINE ELIZABETH-MCMENAMIN (MOT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:ELIZABETH-MCMENAMIN
Last Name:WILL
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BOW LN
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9183
Mailing Address - Country:US
Mailing Address - Phone:484-363-0202
Mailing Address - Fax:
Practice Address - Street 1:3075 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403
Practice Address - Country:US
Practice Address - Phone:610-265-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008234171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor