Individual
MS. JENNIFER J. MAHAFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3024
WI
363AS0400X
Surgical Physician Assistant
Primary
3024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265789234
—
WI
Enumeration date
08/09/2012
Last updated
05/25/2022
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