Basic Information
| Provider Information | |||||||||
| NPI: | 1144207440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAULER | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8280 YANKEE ST | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454581806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374364658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8701 OLD TROY PIKE | ||||||||
| Address2: | |||||||||
| City: | HUBER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454241066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375583338 | ||||||||
| FaxNumber: | 9375583349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207P00000X | 34008335 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 146D00000X | 34008335 | OH | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 207Q00000X | 34008335 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2599013 | 05 | OH | MEDICAID |