Provider Demographics
NPI:1245736941
Name:WHOLE WOMAN HOLISTIC GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:WHOLE WOMAN HOLISTIC GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M H
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-697-0742
Mailing Address - Street 1:365 EDGEMEER PL
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1402
Mailing Address - Country:US
Mailing Address - Phone:630-697-0742
Mailing Address - Fax:
Practice Address - Street 1:23 ERIC NORD WAY STE 1
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1583
Practice Address - Country:US
Practice Address - Phone:440-533-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131434261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center