1922136407 NPI number — JENNIFER CHRISTINE ABERNATHY RD

Table of content: JENNIFER CHRISTINE ABERNATHY RD (NPI 1922136407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922136407 NPI number — JENNIFER CHRISTINE ABERNATHY RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABERNATHY
Provider First Name:
JENNIFER
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHWEITZER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922136407
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:
PO BOX 2060
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54702-2060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 STEIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAU CLAIRE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54701-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-831-0100
Provider Business Practice Location Address Fax Number:
715-831-0108
Provider Enumeration Date:
02/28/2007

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: 133V00000X , with the licence number:  1231 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 804979 . This is a "ADA CERT" identifier . This identifiers is of the category "OTHER".




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