Healthcare Provider Details

I. General information

NPI: 1235314725
Provider Name (Legal Business Name): JENNY A VAN DUYNE MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9770 S MCCARRAN BLVD
RENO NV
89523
US

IV. Provider business mailing address

9770 S MCCARREN BLVD
RENO NV
89523
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-4589
  • Fax: 775-322-3787
Mailing address:
  • Phone: 775-322-4589
  • Fax: 775-322-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number9031
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9031
License Number StateNV

VIII. Authorized Official

Name: JENNY A VAN DUYNE
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 775-322-4589