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General NPI Number Information
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NPI Number | 1528473204
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Entity Type | Individual
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Provider Name | JENNIFER GILLETTE
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Gender | Female
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Dates
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Enumeration Date | 06/21/2014
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Last Update Date | 06/21/2014
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Provider Practice Location Address
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Address Line | 5690 YORKHULL CT APT B
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City | COLUMBUS
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State | OH
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Zip | 43229-3847
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Country | US
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Telephone | 419-303-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 5690 YORKHULL CT APT B
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City | COLUMBUS
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State | OH
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Zip | 43229-3847
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Country | US
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Telephone | 419-303-0166
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 65.000264
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 33.013396
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License Number State | OH
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