Provider Demographics
NPI:1912156258
Name:FERRIS, JENNY L (PA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:FERRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-2019
Mailing Address - Country:US
Mailing Address - Phone:570-268-4096
Mailing Address - Fax:570-265-7824
Practice Address - Street 1:380 YORK AVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-2019
Practice Address - Country:US
Practice Address - Phone:570-268-4096
Practice Address - Fax:570-265-7824
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant