Provider Demographics
NPI:1730669987
Name:GRASMEDER, JEFFREY BERNARD (CRNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BERNARD
Last Name:GRASMEDER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-1343
Mailing Address - Country:US
Mailing Address - Phone:724-309-0844
Mailing Address - Fax:
Practice Address - Street 1:EXCELA HEALTH PENN TOWNSHIP PRIMARY CARE
Practice Address - Street 2:3520 PA-130
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642
Practice Address - Country:US
Practice Address - Phone:724-744-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty