Healthcare Provider Details

I. General information

NPI: 1104881598
Provider Name (Legal Business Name): JENNIFER J STAUSS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNNE JENKINS

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 TATE BLVD SE STE 170
HICKORY NC
28602-4042
US

IV. Provider business mailing address

915 TATE BLVD SE STE 170
HICKORY NC
28602-4042
US

V. Phone/Fax

Practice location:
  • Phone: 828-345-0800
  • Fax: 828-345-0350
Mailing address:
  • Phone: 828-345-0800
  • Fax: 828-345-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number96155
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: