Healthcare Provider Details

I. General information

NPI: 1700827342
Provider Name (Legal Business Name): JENNIFER L. GREENING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NIELSON ST EM DEPT
WATSONVILLE CA
95076-2468
US

IV. Provider business mailing address

75 NEILSON ST EMERGENCY DEPARTMENT
WATSONVILLE CA
95076-2468
US

V. Phone/Fax

Practice location:
  • Phone: 831-761-5613
  • Fax:
Mailing address:
  • Phone: 831-761-5631
  • Fax: 831-761-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: