Healthcare Provider Details

I. General information

NPI: 1154633394
Provider Name (Legal Business Name): JENNIFER MICHELLE OZAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2010
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 3RD ST
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-3200
  • Fax: 336-890-3290
Mailing address:
  • Phone: 336-274-6515
  • Fax: 336-691-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125.058989
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2017-01907
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: