Basic Information
| Provider Information | |||||||||
| NPI: | 1235457631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EFFLER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 3591 MCKINNEY ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | MELISSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754549572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728371075 | ||||||||
| FaxNumber: | 9728374120 | ||||||||
| Practice Location | |||||||||
| Address1: | 3591 MCKINNEY ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | MELISSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728371075 | ||||||||
| FaxNumber: | 9728374120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2010 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041353149 | IL | N | Nursing Service Providers | Registered Nurse | 163W00000X | 898686 | TX | N | Nursing Service Providers | Registered Nurse | 363L00000X | 209-008242 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | AP131058 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.