Basic Information
| Provider Information | |||||||||
| NPI: | 1609002989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLINTON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 W 38TH ST | ||||||||
| Address2: | NEONATALOGY DEPARTMENT | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241086 | ||||||||
| FaxNumber: | 5123241848 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 W 38TH ST | ||||||||
| Address2: | NEONATALOGY DEPARTMENT | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241086 | ||||||||
| FaxNumber: | 5123241848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2009 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0002X | 668784 | TX | Y | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care |
No ID Information.