Provider Demographics
NPI:1881135762
Name:PLANETA, JENNIFER (DIPL AC( NCCAOM))
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PLANETA
Suffix:
Gender:F
Credentials:DIPL AC( NCCAOM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 LEEWARD WAY, #49
Mailing Address - Street 2:
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-690-3833
Mailing Address - Fax:
Practice Address - Street 1:16-1 FRENCHMAN'S BAY
Practice Address - Street 2:
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-690-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-14064-1L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist