Provider Demographics
NPI:1275020083
Name:KILLMER, JEANNIE
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:KILLMER
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 1:555 POLK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3333
Mailing Address - Country:US
Mailing Address - Phone:415-202-2816
Mailing Address - Fax:
Practice Address - Street 1:555 POLK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3333
Practice Address - Country:US
Practice Address - Phone:415-202-2816
Practice Address - Fax:415-346-0483
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator