Provider Demographics
NPI:1538329735
Name:DIZES, JENNIFER LYNNE (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:DIZES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3545 LAFAYETTE AVE
Mailing Address - Street 2:SALUS CENTER 2ND FLOOR
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1314
Mailing Address - Country:US
Mailing Address - Phone:314-977-9339
Mailing Address - Fax:314-977-7529
Practice Address - Street 1:3545 LAFAYETTE AVE
Practice Address - Street 2:SALUS CENTER 2ND FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1314
Practice Address - Country:US
Practice Address - Phone:314-977-9339
Practice Address - Fax:314-977-7529
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121004163W00000X
IL041314462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse