Basic Information
| Provider Information | |||||||||
| NPI: | 1053735647 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YEAGER | ||||||||
| FirstName: | JENNA | ||||||||
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| Credential: | PA-C, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4126 N HOLLAND SYLVANIA RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194739500 | ||||||||
| FaxNumber: | 4194739501 | ||||||||
| Practice Location | |||||||||
| Address1: | 7640 SYLVANIA AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435609263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195178178 | ||||||||
| FaxNumber: | 4195178188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2014 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 50.004005 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.