Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 45206 | KS |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 53-45206-011 | KS |
NPI | 1003293481 |
---|---|
Provider Name | Mrs. Jennifer L Prinz-Shakespeare |
First Address | Junction City, KS 66441-4845 |
Second Address | Junction City, KS 66441-4845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2015 |
Last Update Date | 20/10/2016 |