Basic Information
| Provider Information | |||||||||
| NPI: | 1467105809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | JAILENE | ||||||||
| MiddleName: | HENESSEY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63504 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191477304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864707381 | ||||||||
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| Practice Location | |||||||||
| Address1: | 930 W STREET RD | ||||||||
| Address2: | |||||||||
| City: | WARMINSTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189743124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673875200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2022 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.