Healthcare Provider Details

I. General information

NPI: 1740303056
Provider Name (Legal Business Name): JENNIFER DENISE MCGREW CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DENISE CLEARY

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 HEAVENS DR SUITE 201
MANDEVILLE LA
70471-2890
US

IV. Provider business mailing address

848 W 24TH ST
HOUSTON TX
77008-1738
US

V. Phone/Fax

Practice location:
  • Phone: 985-845-4538
  • Fax: 866-845-8810
Mailing address:
  • Phone: 281-250-7055
  • Fax: 832-519-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: