Provider Demographics
NPI:1477862852
Name:PODJED, NICOLE LEEANN (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEEANN
Last Name:PODJED
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 1:826 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4459
Mailing Address - Country:US
Mailing Address - Phone:610-415-1100
Mailing Address - Fax:610-415-1101
Practice Address - Street 1:826 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4459
Practice Address - Country:US
Practice Address - Phone:610-415-1100
Practice Address - Fax:610-415-1101
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical