Basic Information
| Provider Information | |||||||||
| NPI: | 1063912616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIRAR | ||||||||
| FirstName: | JENNA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7601 HOSPITAL DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958235408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166893433 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7601 HOSPITAL DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166893433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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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 | 363A00000X | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.