Provider Demographics
NPI:1245981075
Name:FELDER, JENNIFER (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FELDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10890 CODY LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8945
Mailing Address - Country:US
Mailing Address - Phone:616-510-0369
Mailing Address - Fax:833-277-8473
Practice Address - Street 1:10890 CODY LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8945
Practice Address - Country:US
Practice Address - Phone:616-510-0369
Practice Address - Fax:833-277-8473
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28242822C163W00000X
TN28242822C163W00000X
OHRN.326938163W00000X
IN28242822C163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse