Provider Demographics
NPI:1649885591
Name:HOWARD, JENNIFER (LMBT 16428)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LMBT 16428
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 PEACEFORD AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5015
Mailing Address - Country:US
Mailing Address - Phone:347-733-4159
Mailing Address - Fax:
Practice Address - Street 1:268 PEACEFORD AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5015
Practice Address - Country:US
Practice Address - Phone:347-733-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist