Healthcare Provider Details

I. General information

NPI: 1528619533
Provider Name (Legal Business Name): JENNIFER PREUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
PITTSBURGH PA
15219-2702
US

IV. Provider business mailing address

1594 GLACKEN AVE
JOHNSTOWN PA
15909-1225
US

V. Phone/Fax

Practice location:
  • Phone: 814-240-8141
  • Fax:
Mailing address:
  • Phone: 814-421-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: