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Individual
JENNIFER A CASTELLUCCIO
Active
Individual
JENNIFER A CASTELLUCCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
OA10000132
WA
363AM0700X
Medical Physician Assistant
OA10000132
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016090
—
WA
Enumeration date
10/06/2005
Last updated
08/17/2021
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