Provider Demographics
NPI:1679657274
Name:WESTON, JENNIFER YIRSA (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:YIRSA
Last Name:WESTON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6208
Practice Address - Street 1:3955 PATIENT CARE DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4299
Practice Address - Country:US
Practice Address - Phone:517-374-7600
Practice Address - Fax:855-495-5457
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679657274Medicaid
MION23570Medicare ID - Type Unspecified
MIC37626093Medicare PIN