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NPI Code Detail

MEDICARE: JENNA FULFORD CHW

MEDICARE: JENNA FULFORD CHW
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1497438758
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA FULFORD CHW
Provider Business Mailing Address
First Line : 1821 UNIVERSITY AVE W STE S306A
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-2874
Country : US
Telephone Number : 651-315-4905
Fax Number :
Provider Business Practice Location Address
First Line : 1821 UNIVERSITY AVE W STE S306A
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-2874
Country : US
Telephone Number : 651-315-4905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2023
Last Update Date : 08/11/2023

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