Provider Demographics
NPI:1467011288
Name:JIMENEZ, JENNIFER STEPHANIE (DPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:STEPHANIE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVENUE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 WOODBURN RD STE 208
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1200
Practice Address - Country:US
Practice Address - Phone:703-942-9845
Practice Address - Fax:703-560-1329
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist