Provider Demographics
NPI:1497215750
Name:OFONTANELLA, JENNAFER G
Entity Type:Individual
Prefix:
First Name:JENNAFER
Middle Name:G
Last Name:OFONTANELLA
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 1:3220 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7899
Mailing Address - Country:US
Mailing Address - Phone:907-364-2663
Mailing Address - Fax:
Practice Address - Street 1:3220 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7899
Practice Address - Country:US
Practice Address - Phone:907-364-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist