Provider Demographics
NPI:1952416315
Name:SZYPCZAK, JENNIFER R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:SZYPCZAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VANDERBILT PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1736
Mailing Address - Country:US
Mailing Address - Phone:828-277-8042
Mailing Address - Fax:828-277-8046
Practice Address - Street 1:1 VANDERBILT PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1736
Practice Address - Country:US
Practice Address - Phone:828-277-8042
Practice Address - Fax:828-277-8046
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC521213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC081CUOtherBCBS
NC5908242Medicaid
NC5908242Medicaid
NC081CUOtherBCBS