Provider Demographics
NPI:1790721959
Name:JABLUNOVSKY, BETHANY VERNOCY (PA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:VERNOCY
Last Name:JABLUNOVSKY
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 1:835 HOSPITAL ROAD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-0788
Mailing Address - Country:US
Mailing Address - Phone:724-357-7009
Mailing Address - Fax:724-357-7414
Practice Address - Street 1:835 HOSPITAL ROAD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7121
Practice Address - Fax:724-357-7479
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA 051260363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical