Provider Demographics
NPI:1386076479
Name:MALTHANER, JENNIFER (CNIM)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MALTHANER
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 N CENTRAL EXPY
Mailing Address - Street 2:STE 1230
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10440 N CENTRAL EXPY
Practice Address - Street 2:STE 1230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2221
Practice Address - Country:US
Practice Address - Phone:972-835-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2164246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic