Individual
MRS. JENNA ANN PICCOLOMINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
100 RIDGEVIEW DR UNIT 3, SMITHFIELD, PA 15478
(724) 569-8100
(724) 569-8368
Mailing address
100 RIDGEVIEW DR UNIT 3, SMITHFIELD, PA 15478-1650
(724) 569-8100
(724) 569-8368
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA054075
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007288440031
PROMISE GROUP #
PA
Enumeration date
10/02/2009
Last updated
09/21/2022
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