Individual
DR. JACQUELINE MARIA FENNERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1435 G ST, SPRINGFIELD, OR 97477-4113
(541) 735-9420
Mailing address
25121 TRIPP RD, ELMIRA, OR 97437-9612
(415) 219-3875
(541) 302-9481
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00292
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150584
—
OR
Enumeration date
11/27/2006
Last updated
01/14/2025
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