Provider Demographics
NPI:1144610890
Name:THIESSEN, JENNAFER
Entity Type:Individual
Prefix:
First Name:JENNAFER
Middle Name:
Last Name:THIESSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 BALLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-2245
Mailing Address - Country:US
Mailing Address - Phone:518-346-8670
Mailing Address - Fax:518-387-3191
Practice Address - Street 1:428 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2245
Practice Address - Country:US
Practice Address - Phone:518-346-8670
Practice Address - Fax:518-387-3191
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician