Provider Demographics
NPI:1881211241
Name:SUMINSKI, JENNIFER ANNE (CPHT)
Entity Type:Individual
Prefix:PROF
First Name:JENNIFER
Middle Name:ANNE
Last Name:SUMINSKI
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18759 DILLER DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2434
Mailing Address - Country:US
Mailing Address - Phone:586-295-7563
Mailing Address - Fax:
Practice Address - Street 1:18759 DILLER DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2434
Practice Address - Country:US
Practice Address - Phone:586-295-7563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT16907183700000X
MD7387124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No183700000XPharmacy Service ProvidersPharmacy Technician