Provider Demographics
NPI:1861966194
Name:ELSBERND, JENNA MARIE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:ELSBERND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 227TH AVE
Mailing Address - Street 2:
Mailing Address - City:CALMAR
Mailing Address - State:IA
Mailing Address - Zip Code:52132-7591
Mailing Address - Country:US
Mailing Address - Phone:563-419-8228
Mailing Address - Fax:
Practice Address - Street 1:605 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-9206
Practice Address - Country:US
Practice Address - Phone:563-419-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program