Provider Demographics
NPI:1558394387
Name:BATES, JANE E (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:BATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:MICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1023 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6636
Mailing Address - Country:US
Mailing Address - Phone:717-270-9446
Mailing Address - Fax:717-270-5669
Practice Address - Street 1:1023 POPLAR ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6636
Practice Address - Country:US
Practice Address - Phone:717-270-9446
Practice Address - Fax:717-270-5669
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA581595Medicaid
PA141413D99Medicare PIN
PA141415RQJMedicare PIN