Provider Demographics
NPI:1144715814
Name:CHRISMAN, JENNIFER MARIE (LM,CPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:LM,CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 COUNTY ROAD 4509
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-5243
Mailing Address - Country:US
Mailing Address - Phone:214-697-3064
Mailing Address - Fax:
Practice Address - Street 1:4083 COUNTY ROAD 4509
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-5243
Practice Address - Country:US
Practice Address - Phone:214-697-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99338176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20901746OtherDRIVERS LICENSE