Provider Demographics
NPI:1497167639
Name:ALBERT, JENNY WREN
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:WREN
Last Name:ALBERT
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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BELT
Mailing Address - State:MT
Mailing Address - Zip Code:59412-0054
Mailing Address - Country:US
Mailing Address - Phone:406-788-3136
Mailing Address - Fax:406-277-4401
Practice Address - Street 1:220 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:BELT
Practice Address - State:MT
Practice Address - Zip Code:59412
Practice Address - Country:US
Practice Address - Phone:406-788-3136
Practice Address - Fax:406-277-4401
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor