Individual
MRS. JENIFFER LYNN FOVARGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10626 TIBBETTS RD, KIRTLAND, OH 44094-5196
(440) 867-5812
Mailing address
10626 TIBBETTS RD, KIRTLAND, OH 44094-5196
(440) 867-5812
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
4303829
OH
Other
Enumeration date
09/18/2020
Last updated
09/18/2020
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