Provider Demographics
NPI:1699731356
Name:BEAZELL, JONI (PA-C)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:BEAZELL
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 1:236 ELM DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8265
Mailing Address - Country:US
Mailing Address - Phone:724-627-0926
Mailing Address - Fax:724-627-0812
Practice Address - Street 1:236 ELM DR STE 101
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8265
Practice Address - Country:US
Practice Address - Phone:724-627-0926
Practice Address - Fax:724-627-0812
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054186363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical