Provider Demographics
NPI:1043911712
Name:BATES, JENNIFER MICHELLE (MSA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:BATES
Suffix:
Gender:F
Credentials:MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 WATERFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2869
Mailing Address - Country:US
Mailing Address - Phone:812-465-6202
Mailing Address - Fax:618-997-8214
Practice Address - Street 1:6211 WATERFORD BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2869
Practice Address - Country:US
Practice Address - Phone:812-456-6202
Practice Address - Fax:618-997-8214
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician