Provider Demographics
NPI:1487964219
Name:ENSOR, JONELLE LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JONELLE
Middle Name:LYNN
Last Name:ENSOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CMR 402
Mailing Address - Street 2:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:49637-186-7298
Mailing Address - Fax:
Practice Address - Street 1:CMR 402
Practice Address - Street 2:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:49637-186-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054466363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical