Individual
DR. JENNIFER MARIE DEFAZIO
Active
Individual
DR. JENNIFER MARIE DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
2009-01325
NC
207NS0135X
Procedural Dermatology Physician
22380
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153RU
BCBSNC
NC
05
—
5912475
—
NC
Enumeration date
04/06/2007
Last updated
02/07/2024
Update your record
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