Provider Demographics
NPI:1205446911
Name:MOZEKE, JENNIFER (LM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MOZEKE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 CHADWICK CT STE 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3318
Mailing Address - Country:US
Mailing Address - Phone:682-334-3929
Mailing Address - Fax:817-280-9962
Practice Address - Street 1:1726 CHADWICK CT STE 200
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3318
Practice Address - Country:US
Practice Address - Phone:682-334-3929
Practice Address - Fax:817-280-9962
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99416176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX99416OtherTEXAS DEPARTMENT OF LICENSE AND REGULATION