Provider Demographics
NPI:1730647371
Name:EHLE, JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:EHLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BEAUREGARD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1726
Mailing Address - Country:US
Mailing Address - Phone:703-854-1432
Mailing Address - Fax:
Practice Address - Street 1:1800 N BEAUREGARD ST STE 101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1726
Practice Address - Country:US
Practice Address - Phone:703-854-1432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-02
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant