Provider Demographics
NPI:1407163983
Name:BADER, JENNIFER ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BADER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:SCHUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-0059
Mailing Address - Country:US
Mailing Address - Phone:302-632-2048
Mailing Address - Fax:
Practice Address - Street 1:1020 FORREST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2799
Practice Address - Country:US
Practice Address - Phone:302-632-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146N00000X
DEC5-0000728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic