Provider Demographics
NPI:1396049680
Name:DINSDALE, JESSICA LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:DINSDALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:CROMSIGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2090 NE WYATT CT
Mailing Address - Street 2:STE 101
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7691
Mailing Address - Country:US
Mailing Address - Phone:541-382-6447
Mailing Address - Fax:
Practice Address - Street 1:2090 NE WYATT CT STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7691
Practice Address - Country:US
Practice Address - Phone:541-382-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-01
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA181337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant