Provider Demographics
NPI:1427162270
Name:DI STEFANO, JENNIFER ROCHELLE (MPA, PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROCHELLE
Last Name:DI STEFANO
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:420 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2892
Mailing Address - Country:US
Mailing Address - Phone:252-752-4124
Mailing Address - Fax:252-752-6146
Practice Address - Street 1:420 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2892
Practice Address - Country:US
Practice Address - Phone:252-752-4124
Practice Address - Fax:252-752-6146
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103670363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant