Healthcare Provider Details

I. General information

NPI: 1477698603
Provider Name (Legal Business Name): JENNIFER GREINER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 S MADISON ST SUITE 250
APPLETON WI
54915-1800
US

IV. Provider business mailing address

3232 N BALLARD RD SUITE 200
APPLETON WI
54911-8804
US

V. Phone/Fax

Practice location:
  • Phone: 920-730-4429
  • Fax:
Mailing address:
  • Phone: 920-749-9668
  • Fax: 920-734-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2319-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: