Provider Demographics
NPI:1679389548
Name:WEBERS, JENNIFER D
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:WEBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S NORWINE ST
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1630
Mailing Address - Country:US
Mailing Address - Phone:573-631-4589
Mailing Address - Fax:
Practice Address - Street 1:411 S NORWINE ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1630
Practice Address - Country:US
Practice Address - Phone:573-631-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor