Provider Demographics
NPI:1467815191
Name:LAUGHLIN, JENNA LEIGH (DO)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEIGH
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:LEIGH
Other - Last Name:CULP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 17
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11109 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-672-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0012773207R00000X
IN02006715A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine