1376655340 NPI number — DR. JENNIFER COOK OLDENBURG PH.D.

Table of content: DR. JENNIFER COOK OLDENBURG PH.D. (NPI 1376655340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376655340 NPI number — DR. JENNIFER COOK OLDENBURG PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLDENBURG
Provider First Name:
JENNIFER
Provider Middle Name:
COOK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOK
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376655340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 HORSESHOE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATROBE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15650-9063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-832-9096
Provider Business Mailing Address Fax Number:
724-832-2249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 HUMPHREY RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-4571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-9096
Provider Business Practice Location Address Fax Number:
724-832-2249
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS009312L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 927893 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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