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General NPI Number Information
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NPI Number | 1679772107
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Entity Type | Individual
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Provider Name | JENNY LEE RAVENSCROFT M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2007
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Last Update Date | 07/14/2007
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Provider Practice Location Address
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Address Line | 3601 4TH ST TTUHSC, DEPT. OF PEDIATRICS - ROOM 4B098
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City | LUBBOCK
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State | TX
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Zip | 79430-0002
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Country | US
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Telephone | 806-749-9150
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Fax | 806-747-9914
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Provider Business Mailing Address
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Address Line | 2028 RUNNING BROOK LN
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City | PEARLAND
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State | TX
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Zip | 77584-6778
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | TEMPORARY LICENSE
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License Number State | TX
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