=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285981027
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ZERNEC D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2012
-----------------------------------------------------
Last Update Date | 03/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 HOSPITAL DR
-----------------------------------------------------
City | UKIAH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95482-4531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-463-7330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4830 ORR SPRINGS RD
-----------------------------------------------------
City | UKIAH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95482-9110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-839-1317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | ED0322A
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 16350
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------