Provider Demographics
NPI:1093785982
Name:FOLLWELL, JENNIFER (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FOLLWELL
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 1:521 N YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7806
Mailing Address - Country:US
Mailing Address - Phone:509-221-5222
Mailing Address - Fax:509-221-5271
Practice Address - Street 1:521 N YOUNG ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7806
Practice Address - Country:US
Practice Address - Phone:509-221-5222
Practice Address - Fax:509-221-5271
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114848Medicaid
IL1093785982Medicaid
WAOP61330157OtherSTATE LICENSE NUMBER
IL036114848Medicaid
ILIL3374017Medicare PIN