Provider Demographics
NPI:1326227661
Name:RATTIEN, JENNIFER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:RATTIEN
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 1:724 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4822
Mailing Address - Country:US
Mailing Address - Phone:919-776-6767
Mailing Address - Fax:919-776-6773
Practice Address - Street 1:724 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4822
Practice Address - Country:US
Practice Address - Phone:919-776-6767
Practice Address - Fax:919-776-6773
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01111363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-01111OtherLICENSE