Healthcare Provider Details

I. General information

NPI: 1992735534
Provider Name (Legal Business Name): JENNIFER MORRIS RHODE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN MORRIS M.D.

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S WEBSTER AVE STE 300
GREEN BAY WI
54301-3528
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 920-338-6868
  • Fax: 920-338-6869
Mailing address:
  • Phone: 920-445-7222
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberM-10625
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number088696
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number71440-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: