Basic Information
| Provider Information | |||||||||
| NPI: | 1114960408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRANCIK | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 N EAST ST | ||||||||
| Address2: | P.O. BOX 548 | ||||||||
| City: | WABASH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469921914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2605633131 | ||||||||
| FaxNumber: | 2605692375 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | PERU | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469701638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654728000 | ||||||||
| FaxNumber: | 2604792917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01070362A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100270190B | 05 | IN | MEDICAID | 201044240 | 01 | IN | MEDICARE | OTHER |