Provider Demographics
NPI:1891203220
Name:JE SURGICAL ASSISTANT
Entity Type:Organization
Organization Name:JE SURGICAL ASSISTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:EVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA CNOR
Authorized Official - Phone:609-432-2152
Mailing Address - Street 1:21 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6996
Mailing Address - Country:US
Mailing Address - Phone:609-432-2152
Mailing Address - Fax:
Practice Address - Street 1:21 HARTFORD DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6996
Practice Address - Country:US
Practice Address - Phone:609-432-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12053400251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care