Provider Demographics
NPI:1205873221
Name:DULANEY, JENNIFER WOERNER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WOERNER
Last Name:DULANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 REUBEN ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624
Mailing Address - Country:US
Mailing Address - Phone:830-997-3132
Mailing Address - Fax:830-997-6175
Practice Address - Street 1:816 REUBEN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624
Practice Address - Country:US
Practice Address - Phone:830-997-3132
Practice Address - Fax:830-997-6175
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040361001Medicaid
TXG73451Medicare UPIN
TX82400KMedicare ID - Type Unspecified