Individual
JAYNE R PENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110003827
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10120878P
OPTIMA HEALTH
VA
05
—
1578825105
—
NC
05
—
1578825105
—
VA
01
—
PAR
USA MANAGED CARE
VA
Enumeration date
06/11/2012
Last updated
06/10/2015
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