Provider Demographics
NPI:1740250968
Name:NYITRAY, JENNIFER L (PA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:NYITRAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2494
Mailing Address - Country:US
Mailing Address - Phone:419-394-3335
Mailing Address - Fax:
Practice Address - Street 1:975 HAGER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2420
Practice Address - Country:US
Practice Address - Phone:419-394-9992
Practice Address - Fax:419-394-9629
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068216Medicaid
OHPA25441Medicare PIN
OHQ50510Medicare UPIN