Provider Demographics
NPI:1558397075
Name:JENC, JANE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:JENC
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:425 ELM ST N
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM - SAUK CENTRE
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1010
Mailing Address - Country:US
Mailing Address - Phone:320-352-6591
Mailing Address - Fax:320-352-5164
Practice Address - Street 1:425 ELM ST N
Practice Address - Street 2:CENTRACARE HEALTH SYSTEM - SAUK CENTRE
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1010
Practice Address - Country:US
Practice Address - Phone:320-352-6591
Practice Address - Fax:320-352-5164
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-09-20
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Provider Licenses
StateLicense IDTaxonomies
MN9244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA970025632OtherRAILROAD MEDICARE
MN73A62JEOtherBCBS
MN989716000Medicaid
MNN003453OtherCHAMPUS
MN970000132Medicare ID - Type Unspecified
MN73A62JEOtherBCBS
GA970025632OtherRAILROAD MEDICARE