Provider Demographics
NPI:1316155591
Name:EICKHOFF, JENNIFER MICHELLE (FNP-BC, MSN ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:EICKHOFF
Suffix:
Gender:F
Credentials:FNP-BC, MSN ATC, LAT
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Mailing Address - Street 1:112 PIPER HILL DR STE 9
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1690
Mailing Address - Country:US
Mailing Address - Phone:636-441-3444
Mailing Address - Fax:
Practice Address - Street 1:112 PIPER HILL DR STE 9
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:636-441-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060299262255A2300X
MO2011010505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer