Provider Demographics
NPI:1881445674
Name:BENDER, JENNIFER CORINNE (RN-C, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CORINNE
Last Name:BENDER
Suffix:
Gender:F
Credentials:RN-C, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MON HEALTH MEDICAL PARK DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1168
Mailing Address - Country:US
Mailing Address - Phone:304-599-6811
Mailing Address - Fax:
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DR STE 2100
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1168
Practice Address - Country:US
Practice Address - Phone:304-599-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV68610163WP0808X, 163WP1700X, 163WX0003X
VAL-13451163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient