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Individual

MRS. JENNIFER SUNDSTROM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
3737 SOUTHERN BLVD STE 2000, KETTERING, OH 45429-1285
(937) 228-4126
(937) 228-0247
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1306
(937) 522-7017

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
RN.273729
OH
363LP2300X
Primary Care Nurse Practitioner
Primary
RN.273729
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0165479
OH
Enumeration date
03/28/2016
Last updated
03/08/2021
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