Basic Information
Provider Information
NPI: 1295822146
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUNTER
FirstName: JENNIFER
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5010
Address2:  
City: MINOT
State: ND
PostalCode: 587025010
CountryCode: US
TelephoneNumber: 7018575650
FaxNumber: 7018575031
Practice Location
Address1: 1500 24TH AVE SW
Address2:  
City: MINOT
State: ND
PostalCode: 587016905
CountryCode: US
TelephoneNumber: 7018575760
FaxNumber: 7018575042
Other Information
ProviderEnumerationDate: 10/10/2006
LastUpdateDate: 05/24/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X7976NDY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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