Provider Demographics
NPI:1982710349
Name:JEWELL, CORINNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:L
Last Name:JEWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CORINNA
Other - Middle Name:JEWELL
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5560 KIETZKE LN
Mailing Address - Street 2:BLDG A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3019
Mailing Address - Country:US
Mailing Address - Phone:775-322-7811
Mailing Address - Fax:775-322-1431
Practice Address - Street 1:5560 KIETZKE LN
Practice Address - Street 2:BLDG A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3019
Practice Address - Country:US
Practice Address - Phone:775-322-7811
Practice Address - Fax:775-322-1431
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA996363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1982710349Medicaid
NV1982710349Medicaid
Q71778Medicare UPIN