Provider Demographics
NPI:1669433728
Name:GEISHAUSER, JENNIFER ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:GEISHAUSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2907 PLEASANT VALLEY BLVD
Mailing Address - Street 2:JAMES E VAN ZANDT MEDICAL CENTER
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-940-7876
Mailing Address - Fax:814-940-7885
Practice Address - Street 1:2907 PLEASANT VALLEY BLVD
Practice Address - Street 2:JAMES E VAN ZANDT MEDICAL CENTER
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-940-7876
Practice Address - Fax:814-940-7885
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002683L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1451286OtherHIGHMARK
PA1451286OtherHIGHMARK
PAS84029Medicare UPIN