Provider Demographics
NPI:1326547019
Name:NEUFFER, JENICA RAE
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:RAE
Last Name:NEUFFER
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 1:190 SW BRUMBACK ST # 2255
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6899
Mailing Address - Country:US
Mailing Address - Phone:541-760-2281
Mailing Address - Fax:
Practice Address - Street 1:4060 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5347
Practice Address - Country:US
Practice Address - Phone:541-760-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist