MEDICARE: JENNIFER HAULER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	34008335	OH
2	146D00000X	Personal Emergency Response Attendant	34008335	OH
3	207Q00000X	Family Medicine Physician	34008335	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144207440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HAULER DO

Provider Business Mailing Address
First Line	:	8280 YANKEE ST
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1806
Country	:	US
Telephone Number	:	937-436-4658
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 OLD TROY PIKE
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1066
Country	:	US
Telephone Number	:	937-558-3338
Fax Number	:	937-558-3349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/17/2018

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Directions to “ JENNIFER HAULER DO” Practice Location

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