Provider Demographics
NPI:1831261940
Name:UPDYKE, JENNIFER ELIZABETH (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:UPDYKE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1908
Mailing Address - Country:US
Mailing Address - Phone:937-258-2836
Mailing Address - Fax:
Practice Address - Street 1:280 LOONEY RD
Practice Address - Street 2:SUITE101
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4199
Practice Address - Country:US
Practice Address - Phone:937-440-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.282847 NP-09118363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics