Healthcare Provider Details

I. General information

NPI: 1215744917
Provider Name (Legal Business Name): JENNA LEE MCGOWAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W AGENCY RD STE 101
WEST BURLINGTON IA
52655-1647
US

IV. Provider business mailing address

116 N 4TH ST STE 302
BURLINGTON IA
52601-5514
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-4970
  • Fax:
Mailing address:
  • Phone: 727-457-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: