Basic Information
| Provider Information | |||||||||
| NPI: | 1427103407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUNDALE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOFFMAN | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | AT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 701 25TH AVE S | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124552008 | ||||||||
| FaxNumber: | 6124552009 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 25TH AVE S | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124552008 | ||||||||
| FaxNumber: | 6124552009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 211D00000X | Y | Podiatric Medicine & Surgery Service Providers | Assistant, Podiatric |
No ID Information.