Provider Demographics
NPI:1942012158
Name:DEANER, JESSIE (PA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:DEANER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:100 METROPOLITAN PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-7112
Mailing Address - Country:US
Mailing Address - Phone:315-870-9369
Mailing Address - Fax:315-870-9364
Practice Address - Street 1:357 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2658
Practice Address - Country:US
Practice Address - Phone:315-363-8862
Practice Address - Fax:315-363-3326
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY033311363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant