Provider Demographics
NPI:1386410934
Name:JASKIEWICZ, ELLEN (PA-C)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:JASKIEWICZ
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 1:9 TACK LN
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5337
Mailing Address - Country:US
Mailing Address - Phone:864-399-0606
Mailing Address - Fax:
Practice Address - Street 1:1494 W WADE HAMPTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1166
Practice Address - Country:US
Practice Address - Phone:864-757-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant