Basic Information
| Provider Information | |||||||||
| NPI: | 1164862355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENERALLA | ||||||||
| FirstName: | JENILEE | ||||||||
| MiddleName: | APRIL MARY | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 UNIVERSITY DRIVE | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY, H073, C5600 | ||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170330850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175310003 | ||||||||
| FaxNumber: | 7175316491 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 UNIVERSITY DRIVE | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY, H073, C5600 | ||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170330850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175310003 | ||||||||
| FaxNumber: | 7175316491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2013 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.