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Individual

JAYNE R PENNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
825 FAIRFAX AVE, SUITE 445, NORFOLK, VA 23507-1914
(757) 446-8920
(757) 446-5242
Mailing address
PO BOX 936, EVMS MEDICAL GROUP, NORFOLK, VA 23501-0936
(757) 446-8920
(757) 446-5242

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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