Provider Demographics
NPI:1689914095
Name:EARL-PARLER, JORDANA (PA)
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:
Last Name:EARL-PARLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1830
Mailing Address - Country:US
Mailing Address - Phone:484-232-5288
Mailing Address - Fax:570-392-6143
Practice Address - Street 1:3835 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1830
Practice Address - Country:US
Practice Address - Phone:484-232-5288
Practice Address - Fax:570-392-6143
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060237363AM0700X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1588900815Medicaid