Provider Demographics
NPI:1831190321
Name:VOSBURG, JENNIFER BELLO (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BELLO
Last Name:VOSBURG
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 1:5231 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9100
Mailing Address - Country:US
Mailing Address - Phone:225-769-0933
Mailing Address - Fax:225-769-6255
Practice Address - Street 1:5231 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9100
Practice Address - Country:US
Practice Address - Phone:225-769-0933
Practice Address - Fax:225-769-6255
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10454.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP76529Medicare UPIN
LA5N710P355Medicare ID - Type Unspecified