Provider Demographics
NPI:1801679659
Name:MYHRE, JENNIFER AYLESTOCK (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AYLESTOCK
Last Name:MYHRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 HICKORY FLAT RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-3572
Mailing Address - Country:US
Mailing Address - Phone:304-223-9788
Mailing Address - Fax:
Practice Address - Street 1:101 WEST AVE STE 305
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2039
Practice Address - Country:US
Practice Address - Phone:215-885-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043514208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics