Provider Demographics
NPI:1184335002
Name:FANCHER, JENNIFER CAROL (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CAROL
Last Name:FANCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 700 N
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8581
Mailing Address - Country:US
Mailing Address - Phone:219-309-0034
Mailing Address - Fax:
Practice Address - Street 1:709 PLAZA DR STE 1
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-1573
Practice Address - Country:US
Practice Address - Phone:219-728-6091
Practice Address - Fax:877-793-9750
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28174733A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily