Provider Demographics
NPI:1568170579
Name:GUCKENBERGER, JENNIFER RAE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RAE
Last Name:GUCKENBERGER
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 1:530 ASPEN GLEN DR APT 104
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1880
Mailing Address - Country:US
Mailing Address - Phone:406-850-5521
Mailing Address - Fax:
Practice Address - Street 1:530 ASPEN GLEN DR APT 104
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1880
Practice Address - Country:US
Practice Address - Phone:406-850-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion