Provider Demographics
NPI:1790206175
Name:JEROME, BRETT DENNIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:DENNIS
Last Name:JEROME
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:428 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4912
Mailing Address - Country:US
Mailing Address - Phone:717-479-8588
Mailing Address - Fax:
Practice Address - Street 1:1528 PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4641
Practice Address - Country:US
Practice Address - Phone:814-944-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical