Provider Demographics
NPI:1427092899
Name:BOESSMANN, JAYNE (RPA-C)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:BOESSMANN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 LEE RD
Mailing Address - Street 2:102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4257
Mailing Address - Country:US
Mailing Address - Phone:585-254-2594
Mailing Address - Fax:585-254-2812
Practice Address - Street 1:687 LEE RD
Practice Address - Street 2:102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4257
Practice Address - Country:US
Practice Address - Phone:585-254-2594
Practice Address - Fax:585-254-2812
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002524363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00091799600OtherHEALTHNOW
NY02407303Medicaid
109051BJOtherPREFERRED CARE
PA0024Medicare ID - Type Unspecified
S00202Medicare UPIN