Basic Information
| Provider Information | |||||||||
| NPI: | 1003293481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRINZ-SHAKESPEARE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 ST. MARY'S RD. | ||||||||
| Address2: | STE. 309 | ||||||||
| City: | JUNCTION CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664414845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857625437 | ||||||||
| FaxNumber: | 7852103422 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 ST. MARY'S RD. | ||||||||
| Address2: | STE. 309 | ||||||||
| City: | JUNCTION CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664414845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857625437 | ||||||||
| FaxNumber: | 7852103422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 10/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 45206 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 53-45206-011 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.