Healthcare Provider Details

I. General information

NPI: 1023730686
Provider Name (Legal Business Name): JENNIE MAUREEN MCINTRYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5619 MERLIN LN
COUNCIL BLUFFS IA
51501-8745
US

IV. Provider business mailing address

9744 MOCKINGBIRD DR
OMAHA NE
68127-2013
US

V. Phone/Fax

Practice location:
  • Phone: 501-606-1236
  • Fax:
Mailing address:
  • Phone: 402-800-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: