1174842355 NPI number — MS. JENNIFER RENEE MCCURRY P.T.A.

Table of content: MS. JENNIFER RENEE MCCURRY P.T.A. (NPI 1174842355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174842355 NPI number — MS. JENNIFER RENEE MCCURRY P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCURRY
Provider First Name:
JENNIFER
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLAUSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174842355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15801 S 48TH ST
Provider Second Line Business Mailing Address:
APARTMENT 2109
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85048-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-307-1692
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8115 E INDIAN BEND RD
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85250-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-951-6451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2010

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: 225200000X , with the licence number:  6361A , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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