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General NPI Number Information
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NPI Number | 1134349996
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Entity Type | Individual
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Provider Name | JENNIFER LEIGH GWIN NP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 555 WASHINGTON SQ
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City | WASHINGTON
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State | MO
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Zip | 63090-5343
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Country | US
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Telephone | 636-392-2209
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Fax | 636-206-8027
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Provider Business Mailing Address
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Address Line | 1 UNIVERSITY PLZ MSC 8100
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4710
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Country | US
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Telephone | 573-651-2270
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Fax | 573-986-6030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN132417
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 132417
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License Number State | MO
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