Basic Information
| Provider Information | |||||||||
| NPI: | 1811933955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENNINGER | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 N DUKE ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444995 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 N DUKE ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444995 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 03/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA052424 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.