Provider Demographics
NPI:1437699238
Name:DUFFEK, JENNA NICHOLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICHOLE
Last Name:DUFFEK
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 AUBURN ST APT 1111
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1473
Mailing Address - Country:US
Mailing Address - Phone:210-387-2838
Mailing Address - Fax:
Practice Address - Street 1:1701 N INDIANA AVE # 42220
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409-9843
Practice Address - Country:US
Practice Address - Phone:806-834-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT5282246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other