1295763050 NPI number — MRS. JENNIFER LYNN HVOZDOVIC KOERBER ATC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295763050 NPI number — MRS. JENNIFER LYNN HVOZDOVIC KOERBER ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOERBER
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN HVOZDOVIC
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295763050
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:
158 CRUSHED APPLE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-267-7882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 VERMILLION STREET
Provider Second Line Business Practice Location Address:
CAMPUS BOX 77
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-384-6063
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com