Provider Demographics
NPI:1376548982
Name:MEANS, JADE (PA-C)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:MEANS
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 1:1824 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-732-8877
Mailing Address - Fax:717-732-9241
Practice Address - Street 1:1824 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-732-8877
Practice Address - Fax:717-732-9241
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003871363AM0700X
PAMA003622L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPO50432Medicare UPIN
PA0504322LMGMedicare ID - Type UnspecifiedMEDICARE NUMBER