Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 2002014284 | MO |
NPI | 1609012368 |
---|---|
Provider Name | Ms. Jennifer H Fortenberry |
First Address | York, PA 17402-9001 |
Second Address | Harrisburg, PA 17110-9303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2008 |
Last Update Date | 25/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1620177 | GATEWAY MEDICARE ASSURED (01) | PA |
2888522 | HIGHMARK BLUE SHIELD-FREEDOM BLUE (01) | PA |