Provider Demographics
NPI:1801323100
Name:ZIEGRA, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ZIEGRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 BUSINESS DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5204
Mailing Address - Country:US
Mailing Address - Phone:207-402-7926
Mailing Address - Fax:479-582-0778
Practice Address - Street 1:49 PAGE LN
Practice Address - Street 2:
Practice Address - City:BOOTHBAY
Practice Address - State:ME
Practice Address - Zip Code:04537-4328
Practice Address - Country:US
Practice Address - Phone:207-380-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN62790163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse