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General NPI Number Information
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NPI Number | 1619140571
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Entity Type | Individual
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Provider Name | JENNIFER LAUREN HOLDEFER PENUEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | ZRB 739 1530 3RD AVE SOUTH
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City | BIRMINGHAM
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State | AL
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Zip | 35294-0001
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Country | US
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Telephone | 205-975-1334
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Fax |
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Provider Business Mailing Address
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Address Line | 3921 FRONTIER ST
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City | NORTHPORT
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State | AL
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Zip | 35475-4658
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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