Provider Demographics
NPI:1356987747
Name:CUENI, JENNIFER ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:CUENI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 BRANDYWINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3107
Mailing Address - Country:US
Mailing Address - Phone:412-926-8694
Mailing Address - Fax:
Practice Address - Street 1:2120 BRANDYWINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3107
Practice Address - Country:US
Practice Address - Phone:412-926-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005108363A00000X
PAMA061284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant