Provider Demographics
NPI:1912746579
Name:UNKEL, JENNIFER LEE (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:UNKEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35697 BENNETT ROAD
Mailing Address - Street 2:
Mailing Address - City:GREEN RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:65332
Mailing Address - Country:US
Mailing Address - Phone:660-221-2914
Mailing Address - Fax:
Practice Address - Street 1:331 SIJAN AVE.
Practice Address - Street 2:
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305
Practice Address - Country:US
Practice Address - Phone:660-687-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022697163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management