Provider Demographics
NPI:1003293481
Name:PRINZ-SHAKESPEARE, JENNIFER L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:PRINZ-SHAKESPEARE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 ST. MARY'S RD.
Mailing Address - Street 2:STE. 309
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4845
Mailing Address - Country:US
Mailing Address - Phone:785-762-5437
Mailing Address - Fax:785-210-3422
Practice Address - Street 1:1106 ST. MARY'S RD.
Practice Address - Street 2:STE. 309
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4845
Practice Address - Country:US
Practice Address - Phone:785-762-5437
Practice Address - Fax:785-210-3422
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45206363L00000X
KS53-45206-011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA3578011Medicare PIN