Provider Demographics
NPI:1356166953
Name:DELLASEGA, JAN MARIE SAN JUAN (AGNP-C)
Entity type:Individual
Prefix:
First Name:JAN MARIE
Middle Name:SAN JUAN
Last Name:DELLASEGA
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N YORK ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-2778
Mailing Address - Country:US
Mailing Address - Phone:717-516-1290
Mailing Address - Fax:
Practice Address - Street 1:507 N YORK ST STE 3A
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-2778
Practice Address - Country:US
Practice Address - Phone:717-516-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner