Provider Demographics
NPI:1770201154
Name:GEMMER, JENNIFER REBECCA (RRA, RT(R))
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:GEMMER
Suffix:
Gender:F
Credentials:RRA, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SHADY COVE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8174
Mailing Address - Country:US
Mailing Address - Phone:757-572-1644
Mailing Address - Fax:
Practice Address - Street 1:1900 SHADY COVE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8174
Practice Address - Country:US
Practice Address - Phone:757-572-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0132000016243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant