Provider Demographics
NPI:1356454029
Name:CONLON, JENNIFER LEOCADIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEOCADIA
Last Name:CONLON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEOCADIA
Other - Middle Name:
Other - Last Name:CONLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 N CAMERON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6018
Mailing Address - Country:US
Mailing Address - Phone:540-536-1680
Mailing Address - Fax:
Practice Address - Street 1:301 N CAMERON ST STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-536-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-302363AM0700X
VA0110001175363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001175OtherPHYSICIAN ASSISTANT LICENSE