Provider Demographics
NPI:1063685931
Name:NEITZEL, JENNIFER LEE (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:NEITZEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 N OAK TRFWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155
Mailing Address - Country:US
Mailing Address - Phone:918-232-2487
Mailing Address - Fax:816-792-3245
Practice Address - Street 1:1540 NE 96TH STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-412-2900
Practice Address - Fax:816-412-2915
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009004531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics