Provider Demographics
NPI:1568895415
Name:WINTHERS, JENNIFER THU (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:THU
Last Name:WINTHERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:THU
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-5257
Mailing Address - Fax:615-692-0547
Practice Address - Street 1:4315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8605
Practice Address - Country:US
Practice Address - Phone:480-870-7500
Practice Address - Fax:480-870-7502
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61115543207R00000X
AZ009645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1568895415Medicaid