Healthcare Provider Details

I. General information

NPI: 1144207440
Provider Name (Legal Business Name): JENNIFER HAULER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 OLD TROY PIKE
HUBER HEIGHTS OH
45424-1066
US

IV. Provider business mailing address

8280 YANKEE ST
CENTERVILLE OH
45458-1806
US

V. Phone/Fax

Practice location:
  • Phone: 937-558-3338
  • Fax: 937-558-3349
Mailing address:
  • Phone: 937-436-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number34008335
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34008335
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: