Provider Demographics
NPI:1649385279
Name:PHEMISTER, JEAN ANN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ANN
Last Name:PHEMISTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:SENSMEIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:510 LINCOLN DRIVE
Mailing Address - Street 2:SOURTHERN ORTHOPEDIC ASSOCIATES SC
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62848
Mailing Address - Country:US
Mailing Address - Phone:618-997-6800
Mailing Address - Fax:618-998-9124
Practice Address - Street 1:510 LINCOLN DRIVE
Practice Address - Street 2:SOURTHERN ORTHOPEDIC ASSOCIATES SC
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62848
Practice Address - Country:US
Practice Address - Phone:618-997-6800
Practice Address - Fax:618-998-9124
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant