Basic Information
| Provider Information | |||||||||
| NPI: | 1831259241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JHU | ||||||||
| FirstName: | JEANNIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2255 YGNACIO VALLEY RD | ||||||||
| Address2: | STE B1 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259457005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 795 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943012302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503214121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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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 | 363AS0400X | PA16282 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AM0700X | PA16282 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA16282 | 01 | CA | STATE LICENSE | OTHER |