Healthcare Provider Details

I. General information

NPI: 1619641412
Provider Name (Legal Business Name): JENNA M HARRINGTON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA M GREENBURG CNA

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10018 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

325 S SUMMIT DR APT A
HOLTS SUMMIT MO
65043-1972
US

V. Phone/Fax

Practice location:
  • Phone: 314-208-6000
  • Fax:
Mailing address:
  • Phone: 573-821-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number139910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: