Provider Demographics
NPI:1942552161
Name:HUNDLEY, JEANNIE MARIE (CST/SA-C)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:MARIE
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:CST/SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 MONVALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704
Mailing Address - Country:US
Mailing Address - Phone:217-787-2700
Mailing Address - Fax:217-787-2715
Practice Address - Street 1:2921 MONVALE DRIVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:217-787-2700
Practice Address - Fax:217-787-2715
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant