Provider Demographics
NPI:1750661401
Name:MEYER, JAIME-LEA BRENNA (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIME-LEA
Middle Name:BRENNA
Last Name:MEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIME-LEA
Other - Middle Name:BRENNA
Other - Last Name:PELLOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:696 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2748
Practice Address - Country:US
Practice Address - Phone:603-429-3155
Practice Address - Fax:603-424-8693
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant