Provider Demographics
NPI:1043309461
Name:IRWIN, JENNIFER L (PA-C MPAS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:IRWIN
Suffix:
Gender:F
Credentials:PA-C MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:7250 CLEARVISTA DR STE 225
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5626
Practice Address - Country:US
Practice Address - Phone:317-537-6088
Practice Address - Fax:317-537-6092
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000967A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP1347715OtherMEDICARE RR PTAN
IN716700029Medicare PIN
INP1347715OtherMEDICARE RR PTAN