Provider Demographics
NPI:1215052352
Name:AVAKIAN, JENNIFER A (CPO)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:AVAKIAN
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SUNNYBROOK RD
Mailing Address - Street 2:STE. 185
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1855
Mailing Address - Country:US
Mailing Address - Phone:919-231-3132
Mailing Address - Fax:919-231-3107
Practice Address - Street 1:23 SUNNYBROOK RD
Practice Address - Street 2:STE. 185
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1855
Practice Address - Country:US
Practice Address - Phone:919-231-3132
Practice Address - Fax:919-231-3107
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222Z00000X
224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist