Provider Demographics
NPI:1962524371
Name:MAENDER, JENNIFER LEVEQUE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEVEQUE
Last Name:MAENDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:LEVEQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7616 BRANFORD PL STE 240
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3794
Mailing Address - Country:US
Mailing Address - Phone:281-240-4313
Mailing Address - Fax:281-240-3646
Practice Address - Street 1:7616 BRANFORD PL STE 240
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3794
Practice Address - Country:US
Practice Address - Phone:281-240-4313
Practice Address - Fax:281-240-3646
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9792207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K7195Medicare PIN