Healthcare Provider Details

I. General information

NPI: 1649298456
Provider Name (Legal Business Name): JENNIFER GREENWOOD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S RIVER RD
DES PLAINES IL
60018-4103
US

IV. Provider business mailing address

822 LIBERTY BELL LN
LIBERTYVILLE IL
60048-3424
US

V. Phone/Fax

Practice location:
  • Phone: 224-612-7000
  • Fax:
Mailing address:
  • Phone: 847-549-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041317458
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.09923595-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: