Provider Demographics
NPI:1295019701
Name:LESEMAN, JENNIFER LYNN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LESEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:SWANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2727 S QUINCY ST APT 812
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2359
Mailing Address - Country:US
Mailing Address - Phone:703-282-2086
Mailing Address - Fax:
Practice Address - Street 1:171 ELDEN ST STE 3B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4834
Practice Address - Country:US
Practice Address - Phone:703-709-9771
Practice Address - Fax:888-519-0045
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030782363AS0400X
VA0110003679363AS0400X
UT12324764-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical