Provider Demographics
NPI:1134598196
Name:MACEK, JENNY I (PA-C)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:I
Last Name:MACEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:IN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4717
Mailing Address - Country:US
Mailing Address - Phone:507-529-6600
Mailing Address - Fax:
Practice Address - Street 1:1650 4TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4717
Practice Address - Country:US
Practice Address - Phone:507-529-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1660363A00000X
TXPA11170363A00000X
MN13247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant