Basic Information
| Provider Information | |||||||||
| NPI: | 1821119272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEESEMAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TROST | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LYN CHEESEMAN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 41464 PENSIVE ST | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206505841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402987512 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25500 POINT LOOKOUT RD | ||||||||
| Address2: | ST MARYS HOSPITAL - EMERGENCY DEPT | ||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206502015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758981 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | C0003203 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.