Provider Demographics
NPI:1881693661
Name:MAJEWSKI, JENNIFER DIANE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:MAJEWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3699 DOGLEG TRL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-5965
Mailing Address - Country:US
Mailing Address - Phone:814-572-5866
Mailing Address - Fax:
Practice Address - Street 1:2060 N PEARL ST
Practice Address - Street 2:VINEYARD PRIMARY CARE
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428
Practice Address - Country:US
Practice Address - Phone:814-877-7711
Practice Address - Fax:814-877-7715
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1540501OtherBLUE SHIELD
NY02635463OtherNY MEDICAL ASSISTANCE
P98855Medicare UPIN
PA073571E7CMedicare PIN