Individual
JACQUELYN ROSE HOLJENCIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
520 EAST 70TH STREET, STARR PAVILION 341, NEW YORK, NY 10021
(646) 962-2064
(646) 962-1605
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09638
NC
363AM0700X
Medical Physician Assistant
013596
NY
363AM0700X
Medical Physician Assistant
MA054062
PA
Other
Enumeration date
12/10/2009
Last updated
02/11/2020
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