Provider Demographics
NPI:1851469654
Name:DONWERTH, JENNIFER JEAN (ANP-BC, GNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:DONWERTH
Suffix:
Gender:F
Credentials:ANP-BC, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BLUFF DALE
Mailing Address - State:TX
Mailing Address - Zip Code:76433-0308
Mailing Address - Country:US
Mailing Address - Phone:254-728-3132
Mailing Address - Fax:254-728-3133
Practice Address - Street 1:1655 AUTUMN VALLEY
Practice Address - Street 2:
Practice Address - City:BLUFF DALE
Practice Address - State:TX
Practice Address - Zip Code:76433-0308
Practice Address - Country:US
Practice Address - Phone:254-728-3132
Practice Address - Fax:254-728-3133
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX587490363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS71167Medicare UPIN