Provider Demographics
NPI:1609328798
Name:FENDLER, JENNIFER LEE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:FENDLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 GENTLE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3881
Mailing Address - Country:US
Mailing Address - Phone:636-978-7004
Mailing Address - Fax:
Practice Address - Street 1:3550 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2535
Practice Address - Country:US
Practice Address - Phone:314-741-0911
Practice Address - Fax:314-653-3670
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015595363LF0000X
MO2016037964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1609328798Medicaid