Individual
JENELLE L JUSTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4111 GATEWAY BLVD, NEWBURGH, IN 47630-8954
(812) 853-5300
(812) 858-4660
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 853-5300
(812) 858-4660
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
02002672A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000305337
BCBS PIN
IN
05
—
200453490
—
IN
Enumeration date
05/31/2005
Last updated
07/02/2013
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