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General NPI Number Information
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NPI Number | 1437699238
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Entity Type | Individual
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Provider Name | JENNA NICHOLE DUFFEK ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 1701 N INDIANA AVE # 42220
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City | LUBBOCK
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State | TX
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Zip | 79409-9843
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Country | US
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Telephone | 806-834-0465
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Fax |
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Provider Business Mailing Address
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Address Line | 5202 AUBURN ST APT 1111
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City | LUBBOCK
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State | TX
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Zip | 79416-1473
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Country | US
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Telephone | 210-387-2838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | AT5282
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License Number State | TX
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