Provider Demographics
NPI:1336231885
Name:ABEYTA, JEAN L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:L
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15660 ENSLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3234
Mailing Address - Country:US
Mailing Address - Phone:202-745-8524
Mailing Address - Fax:
Practice Address - Street 1:15660 ENSLEIGH LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3234
Practice Address - Country:US
Practice Address - Phone:202-745-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000734363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical