Basic Information
| Provider Information | |||||||||
| NPI: | 1962447813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARADER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOLTWICK | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | REBECCA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | DEPT CH 14389 | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600554389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852955307 | ||||||||
| FaxNumber: | 7852707646 | ||||||||
| Practice Location | |||||||||
| Address1: | 2835 SW MISSION WOODS DR | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666145616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852711818 | ||||||||
| FaxNumber: | 7852320739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 03/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-32458 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.