Provider Demographics
NPI:1114140217
Name:DETZEL, JENNIFER J (RN, CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:DETZEL
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 11013
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-1422
Mailing Address - Fax:513-636-3220
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 11013
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-1422
Practice Address - Fax:513-636-3220
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.08341363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner