Provider Demographics
NPI:1740489855
Name:ATZEN, JENNIFER H (ARNP,CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:ATZEN
Suffix:
Gender:F
Credentials:ARNP,CNM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:H
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5350 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2709
Mailing Address - Country:US
Mailing Address - Phone:563-355-1853
Mailing Address - Fax:563-359-1512
Practice Address - Street 1:5350 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2709
Practice Address - Country:US
Practice Address - Phone:563-355-1853
Practice Address - Fax:563-359-1512
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-101469367A00000X
IAB101469367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAB-101469OtherLICENSE