Provider Demographics
NPI:1306007679
Name:LESSNER, JENNY R (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:LESSNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1001 NOBLE ST
Mailing Address - Street 2:TANANA VALLEY CLINIC
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4922
Mailing Address - Country:US
Mailing Address - Phone:907-459-3500
Mailing Address - Fax:907-459-3588
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:TANANA VALLEY CLINIC
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4922
Practice Address - Country:US
Practice Address - Phone:907-459-3500
Practice Address - Fax:907-459-3588
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK7034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1008119Medicaid
AK1008119Medicaid
AK0361450001Medicare NSC
AKK164258Medicare PIN