Healthcare Provider Details

I. General information

NPI: 1053811653
Provider Name (Legal Business Name): JENNIFER UNDERHILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC OKINAWA DEPARTMENT OF GENERAL SURGERY
CAMP FOSTER OKINAWA
96362
JP

IV. Provider business mailing address

PSC 482
FPO AP
96362-1600
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-7148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101270283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: