Provider Demographics
NPI:1346569522
Name:STULL, JENNIFER E (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:STULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:KELBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15840 MEDICAL DR S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7833
Mailing Address - Country:US
Mailing Address - Phone:419-425-3780
Mailing Address - Fax:419-425-6781
Practice Address - Street 1:15840 MEDICAL DR S
Practice Address - Street 2:SUITE B
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-7833
Practice Address - Country:US
Practice Address - Phone:419-425-3780
Practice Address - Fax:419-425-6781
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35099488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine