Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 257625 | AZ |
NPI | 1003481847 |
---|---|
Provider Name | Jennifer Christine Fendler |
First Address | Phoenix, AZ 85050-5408 |
Second Address | Mesa, AZ 85201-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2021 |
Last Update Date | 24/05/2021 |