Provider Demographics
NPI:1659650901
Name:SHOWALTER, JENNIFER BRENT (NURSE PRACTITINER)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BRENT
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:NURSE PRACTITINER
Other - Prefix:
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Mailing Address - Street 1:7720 N FRESNO ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2407
Mailing Address - Country:US
Mailing Address - Phone:559-438-1802
Mailing Address - Fax:559-438-1531
Practice Address - Street 1:7720 N FRESNO ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2407
Practice Address - Country:US
Practice Address - Phone:559-438-1802
Practice Address - Fax:559-438-1531
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20865363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics