Provider Demographics
NPI:1235314725
Name:JENNY A VAN DUYNE MD LTD
Entity Type:Organization
Organization Name:JENNY A VAN DUYNE MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN DUYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-322-4589
Mailing Address - Street 1:9770 S MCCARREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:775-322-4589
Mailing Address - Fax:775-322-3787
Practice Address - Street 1:9770 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:775-322-4589
Practice Address - Fax:775-322-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9031207Y00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016208Medicaid
NV002016208Medicaid