Provider Demographics
NPI:1326312513
Name:MORCELLE, JENA E (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:E
Last Name:MORCELLE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:JENA
Other - Middle Name:E
Other - Last Name:MAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:140 HODGE AVE
Mailing Address - Street 2:2ND FLOOR - PEDIATRIC SURGERY
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2034
Mailing Address - Country:US
Mailing Address - Phone:716-878-7000
Mailing Address - Fax:716-878-7809
Practice Address - Street 1:140 HODGE AVE
Practice Address - Street 2:2ND FLOOR - PEDIATRIC SURGERY
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2034
Practice Address - Country:US
Practice Address - Phone:716-878-7000
Practice Address - Fax:716-878-7809
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP83249363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical