Provider Demographics
NPI:1982089751
Name:MCWHORTER, JENNIFER BERTRAM (RN BSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BERTRAM
Last Name:MCWHORTER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA MEDDAC BAVARIA
Mailing Address - Street 2:CMR 411 BLDG 700 ROSE BARRACKS
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:49966-283-4719
Mailing Address - Fax:49966-284-3721
Practice Address - Street 1:USA MEDDAC BAVARIA
Practice Address - Street 2:CMR 411 BLDG 700 ROSE BARRACKS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:49966-283-4719
Practice Address - Fax:49966-284-3721
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9166343163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOOOtherUPIN