Provider Demographics
NPI:1356348841
Name:MUNSON, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MUNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11397 TERWILLIGERSCREEK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2771
Mailing Address - Country:US
Mailing Address - Phone:513-697-8200
Mailing Address - Fax:859-291-9101
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:2500
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7002
Practice Address - Country:US
Practice Address - Phone:513-697-8200
Practice Address - Fax:859-291-9101
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35051640207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829607Medicaid
OH0699282Medicare PIN
INE96123Medicare UPIN