Provider Demographics
NPI:1811766124
Name:JEWELL, CECILIA ANN
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:ANN
Last Name:JEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12680 PERRY HWY STE 170
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8887
Mailing Address - Country:US
Mailing Address - Phone:412-802-3350
Mailing Address - Fax:412-748-4215
Practice Address - Street 1:12680 PERRY HWY STE 170
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8887
Practice Address - Country:US
Practice Address - Phone:412-802-3350
Practice Address - Fax:412-748-4215
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant