Provider Demographics
NPI:1487964219
Name:ENSOR, JONELLE LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JONELLE
Middle Name:LYNN
Last Name:ENSOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33 BEAVER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2434
Mailing Address - Country:US
Mailing Address - Phone:814-503-8070
Mailing Address - Fax:
Practice Address - Street 1:1036 PARK AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-4028
Practice Address - Country:US
Practice Address - Phone:814-765-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054466363AM0700X
PAOA003156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical