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General NPI Number Information
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NPI Number | 1689301350
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Entity Type | Individual
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Provider Name | AUDREY JENNINGS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 12621 ECKEL JUNCTION RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-1304
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Country | US
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Telephone | 567-868-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 5302 KETUKKEE TRL
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City | TOLEDO
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State | OH
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Zip | 43611-1627
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Country | US
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Telephone | 419-450-0487
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0031999
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License Number State | OH
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