Provider Demographics
NPI:1437375052
Name:ENNIS, JENNIFER HEER (RN,C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HEER
Last Name:ENNIS
Suffix:
Gender:F
Credentials:RN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7503
Mailing Address - Country:US
Mailing Address - Phone:919-781-1800
Mailing Address - Fax:919-781-1899
Practice Address - Street 1:4601 LAKE BOONE TRL
Practice Address - Street 2:SUITE 1B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-781-1800
Practice Address - Fax:919-781-1899
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health