Provider Demographics
NPI:1942893037
Name:DAVENPORT-FURNISS, JENI D (NBC-HWC, CHES)
Entity type:Individual
Prefix:
First Name:JENI
Middle Name:D
Last Name:DAVENPORT-FURNISS
Suffix:
Gender:F
Credentials:NBC-HWC, CHES
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NBC-HWC, CHES
Mailing Address - Street 1:4231 BALBOA AVE # 3040
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:858-361-2286
Mailing Address - Fax:
Practice Address - Street 1:6460 CONVOY CT SPACE 129
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-361-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630902131171400000X
AR7365174H00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty