Provider Demographics
NPI:1437483179
Name:MAINES, JENNIFER I (PA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:I
Last Name:MAINES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:134 BRIDGETON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2616
Mailing Address - Country:US
Mailing Address - Phone:856-507-2783
Mailing Address - Fax:856-221-4138
Practice Address - Street 1:200 ROWAN BLVD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2260
Practice Address - Country:US
Practice Address - Phone:856-507-2783
Practice Address - Fax:856-221-4138
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2024-08-02
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00224700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant